2型糖尿病病人胰岛素抵抗与血浆纤维蛋白原的相关性

发布时间：2019-02-17 09:57

【摘要】：背景与目的:2型糖尿病(T2DM)是一种慢性的血糖代谢紊乱为主、严重影响着人类健康的疾病,表现为从以胰岛素抵抗为主伴随胰岛素进行性分泌不足到以胰岛素进行性分泌不足为主伴随不同程度的胰岛素抵抗,近30年在中国的患病率迅速上升。大血管并发症更是其致残和致死的主要原因。胰岛素抵抗(IR)是指各种原因导致的胰岛素促进葡萄糖摄取和利用效率降低,继而机体代偿性分泌过多的胰岛素所产生的高胰岛素血症。一般认为胰岛素抵抗是引起血糖、血脂、尿酸、血压异常的基础,是代谢综合征发病的重要环节。血浆纤维蛋白原是机体凝血系统的中心蛋白,是血液循环中含量最高的凝血因子,在维持体内纤溶系统和凝血系统的动态平衡中起着至关重要的作用,直接参与了动脉粥样硬化的发生发展。有研究结果显示在肥胖、多囊卵巢综合症(PCOS)、妊娠期糖尿病、老年2型DM患者中胰岛素抵抗与FIB可能相关。本文旨在探讨2型DM患者的血浆纤维蛋白原与胰岛素抵抗的相关性。方法:在排除非2型糖尿病患者以及影响FIB水平的其他因素后,纳入研究者所在医院内分泌科2015年7月至2016年7月期间住院2型糖尿病患者1006例。记录入选者年龄、病程、性别等一般资料,入院后24h内抽取空腹静脉血送本院检验科,进行空腹血糖(FPG)、空腹胰岛素(Fins)、空腹C肽(C-P)、糖化血红蛋白(Hb A1c)、甘油三酯(TG)、血浆胆固醇(Chol)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)、尿酸(UA)、血浆纤维蛋白原(FIB)等相关生化指标测试,并计算HOMA-IR、BMI指数。按所有患者的FIB水平,采用四分位法分为四组。采用SPSS20.0(Ver20.0,IBM,USA)软件进行数据分析。结果:本研究组2型糖尿病病人男性占60.3%,年龄分布于14-90岁,平均年龄55.7±12.7岁,病程分布于0-37年,平均病程7.7±7.0年,BMI分布于14.5-40.0 kg/m2,平均BMI25.3±3.3 kg/m2,28.9%未接受治疗,39.7%接受单纯口服降糖药治疗,14.1%接受单独胰岛素,17.3%接受胰岛素+口服降糖药治疗。单因素方差分析显示FIB四组的年龄、病程、C-P、Hb A1c、LDL-C、Chol随FIB的升高呈增高趋势;女性FIB水平比男性FIB水平高;组间总体差异有统计学意义(P0.05)。以FIB为因变量,以年龄、病程、性别、HOMA-IR、C-P、Hb A1c、BMI、TG、Chol、HDL-C、LDL-C、UA为自变量,进行线性逐步回归分析,结果显示:年龄、病程、性别、C-P、Hb A1c、LDL-C、UA进入回归方程,回归系数分别为:0.011、0.008、-0.197、0.301、0.035、0.109、0.001(P0.05)结论:2型糖尿病患者空腹C肽水平及其所反应的胰岛素抵抗程度可能是血浆纤维蛋白原水平升高的危险因素。
[Abstract]:Background & objective: type 2 diabetes mellitus (T2DM) is a chronic disorder of blood glucose metabolism, which seriously affects human health. In recent 30 years, the prevalence rate of insulin resistance increased rapidly in China, from insulin resistance mainly accompanied by progressive insulin secretion deficiency to insulin progressive secretion insufficiency with different degrees of insulin resistance. Macrovascular complications are the main cause of disability and death. Insulin resistance (IR) refers to the hyperinsulinemia caused by the decrease of glucose uptake and utilization efficiency and the compensatory secretion of insulin. It is generally believed that insulin resistance is the basis of abnormal blood glucose, blood lipids, uric acid and blood pressure, and is an important link in the pathogenesis of metabolic syndrome. Plasma fibrinogen is the central protein of the body's coagulation system and the highest concentration of coagulation factor in the blood circulation. It plays an important role in maintaining the dynamic balance between the fibrinolytic system and the coagulation system in the body. Directly involved in the occurrence and development of atherosclerosis. Studies have shown that insulin resistance may be associated with FIB in obese, polycystic ovary syndrome (PCOS),) gestational diabetes mellitus and elderly type 2 DM patients. The aim of this study was to investigate the relationship between plasma fibrinogen and insulin resistance in patients with type 2 DM. Methods: after excluding non-type 2 diabetic patients and other factors affecting the level of FIB, 1006 patients with type 2 diabetes mellitus were admitted from July 2015 to July 2016 in the Endocrinology Department of our hospital. The age, course and sex of the selected patients were recorded, and fasting venous blood samples were collected within 24 hours after admission to our laboratory for fasting blood glucose (FPG), fasting insulin (Fins), fasting C-peptide (C-P), fasting plasma glucose (FPG), fasting insulin (Fins), fasting C-peptide (C-P). Glycosylated hemoglobin (Hb A1c), triglyceride (TG), plasma cholesterol, (Chol), high density lipoprotein (HDL-C), low density lipoprotein (LDL-C), uric acid (UA), Plasma fibrinogen (FIB) and other related biochemical indexes were measured and HOMA-IR,BMI index was calculated. According to the FIB level of all patients, the quartile method was used to divide into four groups. SPSS20.0 (Ver20.0,IBM,USA) software is used for data analysis. Results: in this study group, 60.3 male patients with type 2 diabetes mellitus were aged 14-90 years with an average age of 55.7 卤12.7 years. The course of disease was distributed between 0-37 years and the mean course of disease was 7.7 卤7.0 years. BMI was distributed in 14.5-40.0 kg/m2, the average BMI25.3 卤3.3 kg/m2,28.9% was not treated, 39.7% received oral hypoglycemic drugs alone, and 14.1% received insulin alone. 17.3% were treated with insulin oral hypoglycemic drugs. Univariate ANOVA analysis showed that the age, course of disease, the level of FIB in women was higher than that in men, and the overall difference between groups was statistically significant (P0.05). Taking FIB as dependent variable, age, course of disease, sex, HOMA-IR,C-P,Hb A _ 1C ~ (+) T _ (TMI) Choll (HDL-C) LDL-CU UA as independent variables, linear stepwise regression analysis was carried out. The results showed that age, course of disease, sex, C-P, and so on. The regression coefficient of Hb A1cU LDL-CU UA was 0.0110.008, and the regression coefficient was 0.0110.0008, respectively. Conclusion: the fasting C-peptide level and the degree of insulin resistance in type 2 diabetes mellitus patients may be the risk factors for the increase of plasma fibrinogen level.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.1

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