血清FGF21水平和颈围与肥胖2型糖尿病的关系

发布时间：2018-06-27 02:44

本文选题：成纤维细胞生长因子21 + 2型糖尿病　；参考：《扬州大学》2017年硕士论文

【摘要】：研究背景和目的成纤维细胞生长因子21(Fibroblast growth factor 21,FGF21)是新近发现的成纤维细胞生长因子家族中的独特一员,它参与全身的代谢调控。FGF21在哺乳动物包括肝脏、脂肪组织、胰腺和骨骼肌等多个组织中都有表达,尤其对降低体重、增加机体胰岛素敏感性具有显著的作用。有研究发现FGF21与糖尿病、肥胖、高脂血症、非酒精性脂肪性肝病(non-alcoholic fatty fiver disease,NAFLD)、代谢综合征、多囊卵巢综合征等多种代谢疾患有关。有研究提出FGF21水平在肥胖、2型糖尿病患者体内增高,但其确切的作用机制尚不明确。本研究观察在2型糖尿病合并肥胖患者体内血清FGF21的水平,探索其是否可应用于临床作为糖尿病、肥胖和其他相关疾病的风险预测因子。方法选取2016年3月-2016年12月在扬州大学附属医院就诊的90例2型糖尿病患者以及同期本院体检中心30例健康者。2型糖尿病组根据体重指数(BMI)分为超重和(或)肥胖组51例和正常体重组39例。记录各组受试者的基本临床信息及检测实验室检查结果,比较各组受试者的颈围(NC)、腰围(WC)、腰臀比(WHR)、总胆固醇(TC)、甘油三酯(TG)、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(HbAlc)、颈动脉内膜中膜厚度(CIMT)、空腹C肽(C-P)、血清FGF21水平。FGF21采用酶联免疫法测定。采用Person相关分析FGF21的相关因素,多因素分析采用二项Logistic回归模型分析2型糖尿病影响因素。结果(1)3组受检者性别构成、年龄、UA、TC、LDL-C无明显统计学差异(P0.05),BMI、NC、WC、WHR、CIMT、FPG、HbA1c、TG、HDL-C、C肽、血清成纤维细胞生长因子21(FGF21)水平间有差异(P0.05);2型糖尿病合并超重/肥胖组患者血清FGF21水平[(663.14±397.82)pg/mL]和2型糖尿病正常体重组血清FGF21水平[(699.01±474.71)pg/mL]均高于对照组[(468.35±304.86)pg/mL]。(2)Spearman 及 Pearson 相关分析显示,FGF21 水平与 NC、WC、WHR、TG 呈正相关(r 值分别为 0.205、0.291、0.392 和 0.233;P 值0.05 和 P0.01);NC 水平与BMI、WC、WHR、CIMT、UA、TG、C-P 呈正相关(r 值分别为 0.628、0.680、0.533、0.507、0.259、0.260 和 0.274;P0.01),与血清 HDL-C 水平呈负相关(r 值为-0.342;P0.01)(见表4);CIMT水平与性别、BMI、WC、WHR呈正相关(r值分别为0.180、0.343、0.422和0.359;P0.05和P0.01),与血清HDL-C水平呈负相关(r值为-0.216,P 值为 0.018)。(3)多因素 Logistic 回归分析显示,FGF21(OR =1.004,P = 0.044)、FPG(OR=40.275,P0.01)是2型糖尿病的独立危险因素。结论(1)高血清FGF21水平可能是2型糖尿病的风险预测因子之一;(2)血清FGF21水平与NC、WC、WHR、TG呈正相关,提示血清FGF21升高与2型糖尿病患者肥胖、高脂血症有关;(3)2型糖尿病患者颈围增粗,且与腰围、腰臀比数值密切相关,将来有可能替代上述2个参数成为筛查腹型肥胖的更简易的测量指标;(4)颈围与CIMT相关,提示NC可能作为糖尿病心血管风险预测因子,对糖尿病患者进行颈围筛查可尽早发现心血管并发症的高危人群。
[Abstract]:Background and objective Fibroblast growth factor 21 (FGF21) is a unique member of the newly discovered fibroblast growth factor family. Many tissues, such as pancreas and skeletal muscle, are expressed, especially in reducing body weight and increasing insulin sensitivity. Studies have found that FGF21 is associated with diabetes, obesity, hyperlipidemia, nonalcoholic fatty liver disease (NAFLD), metabolic syndrome, polycystic ovary syndrome and other metabolic disorders. It has been suggested that the level of FGF21 is increased in obese type 2 diabetic patients, but the exact mechanism of FGF21 level is still unclear. In this study, we observed the serum FGF21 level in patients with type 2 diabetes mellitus and obesity, and explored whether it could be used as a risk factor for diabetes, obesity and other related diseases. Methods from March 2016 to December 2016, 90 patients with type 2 diabetes mellitus and 30 healthy people from the physical examination center of Yangzhou University were divided into overweight and / or fat according to body mass index (BMI). There were 51 cases in fat group and 39 cases in normal weight group. Recording the basic clinical information and testing laboratory results of the subjects in each group, The neck circumference (NC), waist circumference (WC), waist hip ratio (WHR), total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), fasting blood glucose (FPG), glycosylated hemoglobin (HbAlc), carotid intima media thickness (CIMT) were compared. Fasting C-peptide (C-P), serum FGF21 level. FGF21 was determined by enzyme-linked immunosorbent assay (Elisa). The related factors of FGF21 were analyzed by person correlation analysis, and the influencing factors of type 2 diabetes mellitus were analyzed by multivariate logistic regression model. Results (1) there was no significant difference in LDL-C between the three groups (P0.05). There was significant difference in serum fibroblast growth factor 21 (FGF21) levels between patients with type 2 diabetes mellitus complicated with overweight / obesity [(663.14 卤397.82) PG / mL] and normal weight group with type 2 diabetes mellitus [(699.01 卤474.71) PG / mL] compared with control group [(468.35 卤304.86) PG / mL]. (2) Spearman and Pearson correlation analysis. The results showed that the level of FGF21 was positively correlated with TG (r = 0.205, 0.291, P = 0.392 and 0.233, P = 0.05 and P0.01, respectively). The level of NC was positively correlated with the C-P of BMIWCU WCIMTU UAT (r = 0.6280.680, 0.5330.507U 0.259U 0.260 and 0.274P0.01, respectively), and negatively correlated with serum HDL-C (r = -0.342P 0.01) (see Table 4). CIMT level was negatively correlated with gender BMIWCWHR (r = 0.6280.680) and serum HDL-C (r = -0.342g / P0.01). (see Table 4) the level of CIMT was negatively correlated with the gender of BMIWCWHR. Positive correlation (r = 0.180 0, 0.343 卤0.422, P 0.05 and P 0.01), and negative correlation with serum HDL-C level (r = -0.216 P = 0.018). (3) multivariate logistic regression analysis showed that FGF21 (OR 1.004 P = 0.044) FPG (OR40.275 P0.01) was an independent risk factor for type 2 diabetes mellitus. Conclusion (1) the high serum FGF21 level may be one of the risk predictors of type 2 diabetes, (2) the serum FGF21 level is positively correlated with the level of serum NCU WCU WHRG TG, which suggests that the increase of serum FGF21 level may be associated with obesity and hyperlipidemia in type 2 diabetes mellitus patients, (3) the neck circumference of type 2 diabetes mellitus patients is thickened. And it is closely related to waist circumference and waist-to-hip ratio. It is possible to replace the above two parameters as a simple measurement index for abdominal obesity in the future. (4) neck circumference is associated with CIMT, suggesting that NC may be a predictor of cardiovascular risk in diabetes mellitus. Neck screening of diabetic patients can detect cardiovascular complications as early as possible in high risk population.
【学位授予单位】：扬州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.1

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