吸烟对糖调节受损患者血浆同型半胱氨酸浓度的影响

发布时间：2018-12-16 07:41

【摘要】：目的:探讨吸烟与糖调节受损(IGR)患者血浆同型半胱氨酸(Hcy)水平的关系及其可能的机制。方法:选择236例经口服葡萄糖耐量试验(OGTT)确诊的IGR患者,其中吸烟的IGR患者86例作为吸烟IGR组,不吸烟的IGR患者150例作为不吸烟IGR组,另选择年龄、性别构成、体重指数(BMI)与IGR患者相似且不吸烟的70例空腹及OGTT2小时血糖均正常者作为正常对照组。检测3组入选者空腹Hcy,空腹胰岛素(FIns),血糖组份[空腹血糖(FPG)、服用75g无水葡萄糖后2小时血糖(OGTT2hPG)、糖化血红蛋白(HbA1C)],血脂组份[总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG)]及肝肾功能,并计算或测量其胰岛素抵抗指数(HOMA-IR)、体重指数(BMI)、吸烟指数(支数/天×吸烟年限)、收缩压(SBP)、舒张压(DBP)等相关参数,比较各组间上述指标的差异。结果:1、3组入选者在年龄、性别构成、BMI、肌酐、SBP及DBP方面差异无统计学意义(均P0.05)。2、在对照组、不吸烟IGR组、吸烟IGR组3组中,ln(HOMA-IR)、FPG、HbA1C、TC、TG及Hcy水平逐渐升高,差异有统计学意义(P0.05)。吸烟和不吸烟IGR组LDL-C水平均显著高于对照组(P0.05)。而吸烟IGR组的HDL-C水平要低于其他两组(P0.05)。3、吸烟致IGR患者高Hcy血症的危险性:同时调整了年龄、性别、ln(HOMA-IR)、BMI、TG、TC等混杂因素后,吸烟与IGR患者人群高Hcy血症的发生仍密切相关[OR(95%CI)=2.103(1.017~4.348)],P0.05。且吸烟指数越大,血浆Hcy浓度可能越高(F=7.391,P0.01)。4、在236例IGR患者中,其ln(HOMA-IR)与血浆Hcy浓度呈正相关(相关系数r=0.296,P0.01),且ln(HOMA-IR)与HbA1C亦显著正相关(r=0.163,P0.05)。结论:1.不仅糖尿病患者出现Hcy的代谢紊乱,在IGR阶段人群中就已存在血浆Hcy的异常升高。2.吸烟为IGR者高Hcy血症的独立危险因素之一,且吸烟量和IGR患者Hcy浓度之间可能存在一种量效关系。3.在IGR人群中,胰岛素抵抗与其血浆Hcy、HbA1C水平均显著正相关。4.吸烟可加重IGR患者胰岛素抵抗程度,吸烟导致IGR患者高Hcy血症的重要机制之一可能为吸烟所引起的胰岛素抵抗加重。
[Abstract]:Aim: to investigate the relationship between smoking and plasma homocysteine (Hcy) level in (IGR) patients with impaired glucose regulation. Methods: a total of 236 patients with IGR diagnosed by oral glucose tolerance test (OGTT) were selected, including 86 patients with IGR who smoked as smoking IGR group, 150 patients with IGR who did not smoke as non-smoking IGR group. The body mass index (BMI) was similar to that in IGR patients, and 70 cases with normal fasting and OGTT2 blood glucose were taken as normal control group. Fasting Hcy, fasting insulin (FIns), blood glucose component [fasting glucose (FPG), 75 g anhydrous glucose 2 hours blood glucose (OGTT2hPG), glycosylated hemoglobin (HbA1C)], blood lipid component [total cholesterol (TC),] High density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), triglyceride (TG), liver and kidney function, insulin resistance index (HOMA-IR), body mass index (BMI),) were calculated or measured. Smoking index (number / day 脳 smoking years) systolic blood pressure (SBP),) diastolic blood pressure (DBP) and other related parameters were compared among the groups. Results: 1 there was no significant difference in age, sex composition, BMI, creatinine, SBP and DBP among the three groups (P0.05). 2., ln (HOMA-IR, FPG,HbA1C,TC, in the control group, non-smoking IGR group and smoking IGR group) TG and Hcy levels gradually increased, the difference was statistically significant (P0.05). The level of LDL-C in IGR group was significantly higher than that in control group (P 0.05). However, the HDL-C level of smoking IGR group was lower than that of the other two groups (P0.05). The risk of hyperHcy in patients with IGR caused by smoking was adjusted for age, sex, ln (HOMA-IR, BMI,TG,TC and so on. Smoking was still closely related to the incidence of hyperHcy in patients with IGR [OR (95%CI) = 2.103 (1.017 卤4.348), P 0.05]. The higher the smoking index was, the higher the plasma Hcy concentration was (F = 7.391g / P0.01). (4) in 236 patients with IGR, there was a positive correlation between ln (HOMA-IR) and plasma Hcy concentration (r = 0.296, P 0.01). Ln (HOMA-IR) was also positively correlated with HbA1C (r = 0.163, P 0.05). Conclusion: 1. It was not only the metabolic disorder of Hcy in diabetic patients, but also the abnormal increase of plasma Hcy in IGR patients. Smoking is one of the independent risk factors for hyperHcy in IGR patients, and there may be a dose-effect relationship between smoking and Hcy concentration in IGR patients. In IGR population, insulin resistance was significantly positively correlated with plasma Hcy,HbA1C levels. 4. 4. Smoking can aggravate the degree of insulin resistance in patients with IGR. One of the important mechanisms of hyperHcy in patients with IGR may be the increase of insulin resistance caused by smoking.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R589

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