2型糖尿病患者胱抑素C与胰岛素抵抗及β细胞功能的相关性研究
发布时间：2018-07-17 05:58
【摘要】：研究背景：近年来,社会经济飞速发展,在显著提高人民生活质量、改变生活环境的巨同时,也加速了糖尿病在全球范围内的广泛流行。目前糖尿病已成为继恶性肿瘤、心血管疾病之后的第三大严重威胁人类健康的代谢性疾病。2型糖尿病占总糖尿病人数的90%以上,是由遗传因素和环境共同作用引起的一组以糖代谢紊乱为主要表现的临床综合征,胰岛分泌功能减退与胰岛素作用下降为其发病的主要病理生理基础。胱抑素C又称半胱氨酸蛋白酶抑制蛋白C,体内所有有核细胞均可分泌,参与多种蛋白水解调控。已有研究证实,胱抑素C可以预测糖尿病发生,并与糖尿病大血管并发症及糖尿病微血管并发症均密切相关。然而,胱抑素C与糖尿病人群的胰岛功能及胰岛素抵抗之间的关系目前仍少有文献论及。研究目的：本研究以不同C肽释放曲线下面积分别代表基础胰岛功能、早期时相胰岛功能以及全时相胰岛功能,以Homa-IR评估胰岛素抵抗,Homa-S评估胰岛素敏感性,分别比较在2型糖尿病人群中,胱抑素水平与胰岛功能及胰岛素抵抗的是否相关。方法：本研究随机选取部分于2012年6月30日到2015年3月31日期间在山东大学齐鲁医院内分泌科住院治疗的2型糖尿病患者229例作为研究对象。其中男性117例,女性112例,平均年龄58.74±10.30岁,最大85岁,最小26岁。所有研究对象均为自愿参加,均对接受一般信息采集、体格检查及化验室检查。一般信息包括：基本信息、既往病史、家族史、是否服用药物等。体格检查所包括的数据有：身高、体重、腰围。化验室检查结果均为患者空腹8小时、接受胰岛素治疗者停用胰岛素10小时以上后静脉采血所得,包括：总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL)、高密度脂蛋白胆固醇(HDL)、空腹血糖(FPG)、空腹胰岛素(FINS)、糖化血红蛋白(HbA1C)、胱抑素C (Cys-C)、血肌酐(Cr)、血游离脂肪酸(FFA)等。然后,口服75g葡萄糖之后分别于0.5小时、1小时、2小时、3小时留取静脉血测该时刻血糖、胰岛素及C肽。对不同胱抑素水平人群的胰岛功能情况进行比较。数据录入采用Microsoft Office Excel2010,C肽释放曲线下面积计算采用Graph Pad Prism5.所有数据采用SPSS 16.0软件进行统计分析。结果：1.不同水平血清胱抑素C的2型糖尿病患者组间比较显示：随胱抑素C水平升高,年龄、病程、BMI、SBP、血肌酐、冠心病患病率、糖尿病多种并发症患病率、Homa2%B、 AUC2h等均逐渐增加；CCR、Homa2%S则逐渐降低；HomaIR、AUCO.5h在胱抑素C正常范围内随胱抑素C水平升高而升高,在胱抑素C异常组则出现轻度下降。2. Logistic回归分析显示,胱抑素C异常是糖尿病肾病、糖尿病视网膜病变、糖尿病周围神经病变等的独立危险因素。3.校正性别、年龄、BMI、病程、血脂、吸烟史、饮酒史、白细胞以及冠心病史、血肌酐水平等因素后,血清胱抑素C水平与Homa2-IR、0.5小时C肽释放曲线下面积(AUC 0.5h)呈线性正相关。3. Logistic回归分析显示,在2型糖尿病患者中,正常范围偏高的胱抑素C、异常升高的胱抑素C均为胰岛素抵抗的独立危险因素且其危险度随胱抑素C水平升高而升高。4. Logistic回归分析显示,在2型糖尿病患者中,胱抑素C水平不是胰岛功能的独立相关因素。结论：1.随血清胱抑素C水平的升高,各种糖尿病并发症发病率逐渐升高；2.血清胱抑素C升高是2型糖尿病患者胰岛素抵抗的独立危险因素。3.血清胱抑素C水平与2型糖尿病患者的胰岛功能情况未见相关。
[Abstract]:Research background: in recent years, the rapid development of social economy has greatly improved the quality of people's life and changed the living environment greatly. It also accelerated the widespread prevalence of diabetes in the world. At present, diabetes has become the third major serious metabolic disease of human health,.2 diabetes, after malignant tumor and cardiovascular disease. More than 90% of the total number of diabetes mellitus is a group of clinical syndromes, which are caused by the combination of genetic factors and the environment, and the main pathophysiological basis of the pancreatic islet secretory function and the decrease of insulin action. Cystatin C, also known as cystine protease inhibitor C, is all nucleated in the body. Cells can be secreted and participate in a variety of protein hydrolysis regulation. Studies have shown that cystatin C can predict the occurrence of diabetes and is closely related to diabetic macrovascular complications and diabetic microvascular complications. However, there are few literature on the relationship between cystatin C and islet function and islet resistance in diabetic people. Objective: in this study, the area under different C peptide release curves represented basic islet function, early phase islet function and full phase islet function. Insulin resistance was evaluated by Homa-IR, and Homa-S was evaluated for insulin sensitivity. The levels of cystatin and islet function and insulin resistance were compared in type 2 diabetes. Methods: This study randomly selected 229 patients with type 2 diabetes hospitalized at the Department of Endocrinology, Qilu Hospital, Shandong University from June 30, 2012 to March 31, 2015. There were 117 cases of male and 112 women, the average age was 58.74 + 10.30 years old, the oldest was 85, and the smallest was 26 years old. All the subjects were voluntary. General information collection, physical examination and laboratory examination. General information including basic information, past medical history, family history, or not. Physical examination included data included height, weight, waist circumference. The results of the laboratory were all 8 hours in the patient's empty abdomen and 10 hours of insulin treatment for discontinuation of insulin. The above venous blood collection includes: total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL), high density lipoprotein cholesterol (HDL), fasting blood glucose (FPG), fasting insulin (FINS), glycosylated hemoglobin (HbA1C), Cystin C (Cys-C), serum creatinine (Cr), and blood free fatty acid (FFA). Then, after taking orally 75g glucose Don't take 0.5 hours, 1 hours, 2 hours, 3 hours to take venous blood to measure blood sugar, insulin and C peptide. Compare the islet function of people with different cystatin levels. Data entry is Microsoft Office Excel2010, the area of C peptide release curve is calculated by Graph Pad Prism5. data using SPSS 16 software. Results: 1. patients with type 2 diabetic patients with different levels of serum cystatin C showed that with the level of cystatin C, age, course of disease, BMI, SBP, serum creatinine, coronary heart disease, the prevalence of multiple complications, Homa2%B, AUC2h and so on gradually increased; CCR, Homa2%S decreased gradually; HomaIR, AUCO.5h in cystatin was C normal The elevated levels of cystatin C and mild decrease in.2. Logistic regression analysis in the abnormality of cystatin C showed that cystatin C was an independent risk factor for diabetic nephropathy, diabetic retinopathy, and diabetic peripheral neuropathy,.3. correction of sex, age, BMI, course of disease, blood lipid, smoking history, drinking history, leukocyte With the history of coronary heart disease, serum creatinine level and other factors, the serum cystatin C level and Homa2-IR, the area under the 0.5 hour C peptide release curve (AUC 0.5h) were linear and positive correlation.3. Logistic regression analysis showed that in type 2 diabetic patients, the normal range of cystatin C and the abnormal elevated cystatin C were independent risk factors for insulin resistance. The increase in the risk of cystatin C and increased.4. Logistic regression analysis showed that cystatin C level was not an independent factor in islet function in type 2 diabetic patients. Conclusion: 1. with the increase of serum cystatin C level, the incidence of various diabetic complications is gradually increased; 2. serum cystatin C increase is type 2 diabetic patients. The independent risk factor for insulin resistance was.3. serum cystatin C level and no correlation with islet function in type 2 diabetic patients.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R587.1
本文编号：2129317
[Abstract]:Research background: in recent years, the rapid development of social economy has greatly improved the quality of people's life and changed the living environment greatly. It also accelerated the widespread prevalence of diabetes in the world. At present, diabetes has become the third major serious metabolic disease of human health,.2 diabetes, after malignant tumor and cardiovascular disease. More than 90% of the total number of diabetes mellitus is a group of clinical syndromes, which are caused by the combination of genetic factors and the environment, and the main pathophysiological basis of the pancreatic islet secretory function and the decrease of insulin action. Cystatin C, also known as cystine protease inhibitor C, is all nucleated in the body. Cells can be secreted and participate in a variety of protein hydrolysis regulation. Studies have shown that cystatin C can predict the occurrence of diabetes and is closely related to diabetic macrovascular complications and diabetic microvascular complications. However, there are few literature on the relationship between cystatin C and islet function and islet resistance in diabetic people. Objective: in this study, the area under different C peptide release curves represented basic islet function, early phase islet function and full phase islet function. Insulin resistance was evaluated by Homa-IR, and Homa-S was evaluated for insulin sensitivity. The levels of cystatin and islet function and insulin resistance were compared in type 2 diabetes. Methods: This study randomly selected 229 patients with type 2 diabetes hospitalized at the Department of Endocrinology, Qilu Hospital, Shandong University from June 30, 2012 to March 31, 2015. There were 117 cases of male and 112 women, the average age was 58.74 + 10.30 years old, the oldest was 85, and the smallest was 26 years old. All the subjects were voluntary. General information collection, physical examination and laboratory examination. General information including basic information, past medical history, family history, or not. Physical examination included data included height, weight, waist circumference. The results of the laboratory were all 8 hours in the patient's empty abdomen and 10 hours of insulin treatment for discontinuation of insulin. The above venous blood collection includes: total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL), high density lipoprotein cholesterol (HDL), fasting blood glucose (FPG), fasting insulin (FINS), glycosylated hemoglobin (HbA1C), Cystin C (Cys-C), serum creatinine (Cr), and blood free fatty acid (FFA). Then, after taking orally 75g glucose Don't take 0.5 hours, 1 hours, 2 hours, 3 hours to take venous blood to measure blood sugar, insulin and C peptide. Compare the islet function of people with different cystatin levels. Data entry is Microsoft Office Excel2010, the area of C peptide release curve is calculated by Graph Pad Prism5. data using SPSS 16 software. Results: 1. patients with type 2 diabetic patients with different levels of serum cystatin C showed that with the level of cystatin C, age, course of disease, BMI, SBP, serum creatinine, coronary heart disease, the prevalence of multiple complications, Homa2%B, AUC2h and so on gradually increased; CCR, Homa2%S decreased gradually; HomaIR, AUCO.5h in cystatin was C normal The elevated levels of cystatin C and mild decrease in.2. Logistic regression analysis in the abnormality of cystatin C showed that cystatin C was an independent risk factor for diabetic nephropathy, diabetic retinopathy, and diabetic peripheral neuropathy,.3. correction of sex, age, BMI, course of disease, blood lipid, smoking history, drinking history, leukocyte With the history of coronary heart disease, serum creatinine level and other factors, the serum cystatin C level and Homa2-IR, the area under the 0.5 hour C peptide release curve (AUC 0.5h) were linear and positive correlation.3. Logistic regression analysis showed that in type 2 diabetic patients, the normal range of cystatin C and the abnormal elevated cystatin C were independent risk factors for insulin resistance. The increase in the risk of cystatin C and increased.4. Logistic regression analysis showed that cystatin C level was not an independent factor in islet function in type 2 diabetic patients. Conclusion: 1. with the increase of serum cystatin C level, the incidence of various diabetic complications is gradually increased; 2. serum cystatin C increase is type 2 diabetic patients. The independent risk factor for insulin resistance was.3. serum cystatin C level and no correlation with islet function in type 2 diabetic patients.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R587.1
【参考文献】
相关期刊论文 前2条
1 刘烨;张琳;洪天配;;2011年糖尿病学领域的研究进展和热点回顾[J];中国医学前沿杂志(电子版);2011年06期
2 闫萌萌;刘素筠;卓小群;;胱抑素C与2型糖尿病视网膜病变的相关性研究[J];中国药物与临床;2015年01期
，本文编号：2129317
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