不同糖代谢老年人血清鸢尾素水平的比较研究

发布时间：2018-06-03 08:09

本文选题：糖代谢异常 + 老年人　；参考：《郑州大学》2017年硕士论文

【摘要】：目的:鸢尾素(Irisin)是最近几年新发现的一种肌肉因子,研究者认为肌肉因子合成以及分泌的紊乱是导致多种代谢紊乱的机制之一[1]。鸢尾素最主要的生物学功能是通过上调白色脂肪细胞解耦联蛋白Ⅰ(UCP1)促进白色脂肪细胞转化为褐色脂肪细胞,这一效应被称作“白色脂肪褐色化”[2]。白色脂肪褐色化可以使机体的新陈代谢加快、能量消耗增加,也可以调节葡萄糖代谢的平衡,起到抵制肥胖以及胰岛素抵抗的作用[3]。研究发现[4]正常人血清鸢尾素水平显著高于2型糖尿病(T2DM)患者的血清鸢尾素水平,并且2型糖尿病患者血清鸢尾素水平和胰岛素抵抗指数(IR)呈负相关[4],鸢尾素参与了胰岛素抵抗的发生及发展过程[4]。也有研究表明糖尿病肾病(DN)患者血清鸢尾素水平降低,鸢尾素可能和糖尿病肾病患者的糖脂代谢紊乱以及肾功能损伤发生的过程有关[5]。但是目前关于不同糖代谢老年人血清鸢尾素水平的比较研究尚未见报道。我们对140例不同糖代谢老年人的血清鸢尾素浓度及相关临床指标进行了检测和测量,探讨了不同糖代谢状态下老年人血清鸢尾素水平有无差异以及影响老年2型糖尿病患者血清鸢尾素水平的相关因素。方法:随机选取≥60岁的老年人共140例,其中2型糖尿病组(T2DM)34例,空腹血糖受损组(IFG)34例,糖耐量减低组(IGT)36例,糖耐量正常组(NGT)36例。T2DM组的诊断采用1997年美国糖尿病协会(ADA)制定的T2DM诊断标准:出现糖尿病症状(即烦渴、多饮、多尿、难以解释的体重减轻)+(1)一天之中有任意时间静脉血浆葡萄糖浓度≥11.1mmol/L,或(2)空腹超过8小时后的静脉血浆葡萄糖浓度即空腹葡萄糖(FPG)≥7.0 mmol/L,或(3)OGTT2小时的血浆葡萄糖浓度≥11.1mmol/L;空腹血浆葡萄糖浓度在6.1~6.9mmol/L为IFG组;OGTT2h血浆葡萄糖浓度在7.8~11.0mmol/L为IGT组;OGTT 2h血浆葡萄糖浓度≤7.0 mmol/L为NGT组。所有受试者均测量身高、体重、腰围(WC)、臀围,计算体质指数(BMI)、腰臀比(WHR),检测鸢尾素(Irisin)、空腹胰岛素(FIns)、OGTT2h胰岛素、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、空腹血糖(FPG)、糖化血红蛋白(HbA1c)、血肌酐(Cr),估算肾小球滤过率(eGFR)。结果:1.T2DM组、IGT组、IFG组BMI、WHR、HbA1c、TC、TG、LDL-C、eGFR均明显高于NGT组(均P0.05),OGTT2h胰岛素低于NGT组(均P0.05);T2DM组、IGT组、IFG组BMI、WHR、TC、TG、LDL-C、eGFR、HbA1c、OGTT2 h胰岛素相比均无明显差异(均P0.05)。2.T2DM组、IGT组、IFG组血清鸢尾素浓度明显低于NGT组[T2DM、IGT、IFG/NGT=(1.67±1.62)、(2.79±1.67)、(2.35±2.69)/(3.13±2.76)ng/L,F=33.24,均P㩳0.05];T2DM组血清鸢尾素浓度低于IGT组和IFG组[T2DM/IGT、IFG=(1.67±1.62)/(2.79±1.67)、(2.35±2.69)ng/L,均P㩳0.05];IGT组和IFG组之间血清鸢尾素浓度相比无明显差异(P0.05)。3.经Pearson相关分析,老年T2DM组血清鸢尾素浓度与年龄、身高、体重、腰围、臀围、空腹胰岛素、OGTT2h胰岛素、FPG、HDL-C、Cr无明显相关性(均P0.05),与BMI、WHR、TC、TG、LDL-C、HbA1c呈负相关(r=-0.31、-0.29、-0.261、-0.255、-0.238、-0.352,均P0.05),与eGFR呈正相关(r=0.082,P0.05)。4.进一步经多元线性回归分析发现,WHR、HbA1c是T2DM患者血清鸢尾素的主要负性影响因子(标准化回归系数=-3.25,-1.54,均P0.05),固定HbA1c后,WHR升高是老年T2DM组血清鸢尾素浓度下降的独立危险因素。结论:鸢尾素在NGT组、IGT组、IFG组及T2DM组患者血清中的表达呈逐渐下降趋势,WHR、HbA1c是影响老年T2DM患者血清鸢尾素水平的重要的负性因子。
[Abstract]:Objective: irises (Irisin) is a newly discovered muscle factor in recent years. Researchers believe that the synthesis of muscle factors and the disorder of secretion are one of the mechanisms leading to a variety of metabolic disorders. The most important biological function of [1]. is the up-regulation of white adipocyte decoupling protein I (UCP1) to promote white fat cells to browning. Color adipocyte, this effect is called "white fat Brown" [2]. white fat Brown can accelerate metabolism, increase energy consumption, regulate the balance of glucose metabolism, play the role of resisting obesity and insulin resistance, [3]. research shows that the level of Irone in serum of [4] normal people is significantly higher than that of type 2 The level of iris in patients with diabetes mellitus (T2DM), and the negative correlation between the serum iririn level and the insulin resistance index (IR) in type 2 diabetes patients, iririn was involved in the development and development of insulin resistance, [4]. also showed that the level of iris in patients with diabetic nephropathy (DN) decreased, iris and diabetic kidneys were possible. The disorder of glucose and lipid metabolism and the process of renal function injury are related to [5]., but there is no report on the comparative study of the levels of iris in different glycometabolic elderly people. We have detected and measured the serum iris concentration and related clinical indexes in 140 elderly patients with different glucose metabolism, and discussed different sugars. There was no difference in serum Irone level in the elderly and related factors affecting the level of serum Irone in elderly patients with type 2 diabetes. Methods: 140 cases of elderly people aged 60 years old were randomly selected, including 34 cases of type 2 diabetes (T2DM), 34 cases of impaired fasting blood glucose (IFG), 36 cases of impaired glucose tolerance group (IGT), and normal glucose tolerance group (NGT) 3 6 cases of.T2DM were diagnosed by the 1997 American Diabetes Association (ADA) standard of T2DM diagnosis: diabetes symptoms (i. e., polydipsia, polydipsia, polyuria, unexplained weight loss) + (1) the glucose concentration of venous plasma glucose was more than 11.1mmol/L at any time of the day, or (2) the concentration of glucose in the venous plasma after more than 8 hours was empty. Glucose (FPG) was more than 7 mmol/L, or (3) OGTT2 hours of plasma glucose concentration more than 11.1mmol/L; fasting plasma glucose concentration in 6.1~6.9mmol/L was IFG group; OGTT2h plasma glucose concentration in 7.8~11.0mmol/L was IGT group; OGTT 2H plasma glucose concentration was less than 7 mmol/L. All subjects measured height, weight, waist circumference, hip circumference, Calculation of body mass index (BMI), waist to hip ratio (WHR), detection of iridin (Irisin), fasting insulin (FIns), OGTT2h insulin, triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), fasting blood glucose (FPG), glycosylated hemoglobin (HbA1c), blood creatinine (Cr), estimated glomerular filtration rate. Fruit: 1.T2DM group, IGT group, IFG group BMI, WHR, HbA1c, TC, TG, eGFR are obviously higher than NGT group (all P0.05). GT, IFG/NGT= (1.67 + 1.62), (2.79 + 1.67), (2.35 + 2.69) / (3.13 +. 2.76) ng/L, F=33.24, P? 0.05], serum iris concentration in T2DM group was lower than IGT and IFG [T2DM/IGT, IFG= (1.67 + 1.62) / (2.79 + 1.67), (2.35 + 1.67) ng/L. The serum iris concentration in the elderly T2DM group has no significant correlation with age, height, weight, waist circumference, hip circumference, fasting insulin, OGTT2h insulin, FPG, HDL-C, Cr (P0.05). It is negatively correlated with BMI, WHR, TC, TG, LDL-C. The regression analysis found that WHR and HbA1c were the main negative factors of the serum iris in T2DM patients (the normalized regression coefficient =-3.25, -1.54, P0.05). After HbA1c, the increase of WHR was an independent risk factor for the decrease of serum Irone concentration in the elderly group T2DM. Conclusion: the expression of iris in the serum of NGT, IGT, IFG and other groups was gradually Downtrend, WHR and HbA1c are important negative factors that affect serum irises in elderly T2DM patients.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.1

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