血清P选择素、胰高血糖素样肽-1与初诊断2型糖尿病患者胰岛素抵抗的关系
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摘要
目的探讨血清P选择素(sP-selectin)、胰高血糖素样肽-1(GLP-1)的变化与新诊断2型糖尿病(T2DM)患者胰岛素抵抗的关系。方法选取华中科技大学同济医学院附属武汉中心医院2018年6月～2018年12月初诊断的T2DM患者60例(A组)、具有5年以上糖尿病病程的T2DM患者60例(B组)和健康体检人员60例(C组);检测各组血清sP-selectin、GLP-1、空腹胰岛素(FINS)、空腹血糖(FPG)、胰岛素抵抗指数(HOMA-IR)、糖化血红蛋白(HbA1c)及胰岛素敏感指数(ISI),分析血清sP-selectin、GLP-1与HOMA-IR、ISI的相关性。结果 B组的血清sP-selectin显著高于A组和C组(P <0.05),血清GLP-1显著低于A组和C组(P <0.05);A组的血清sP-selectin显著高于C组(P <0.05),血清GLP-1显著低于C组(P <0.05);A组的HOMA-IR、HbA1c、FINS、FPG均显著高于C组(P <0.05),ISI低于C组(P <0.05);初诊断T2DM患者的血清sPselectin与HOMA-IR呈正相关(P <0.05)、与ISI呈负相关(P <0.05);血清GLP-1与HOMA-IR呈负相关(P <0.05)、与ISI呈正相关(P <0.05)。初诊断T2DM患者的血清sP-selectin、腰围(WC)、病程、BMI升高及GLP-1降低将会增大患者HOMA-IR升高的风险(P <0.05);血清sP-selectin、WC、病程升高及GLP-1降低会增大患者ISI降低的风险。结论血清sP-selectin、GLP-1水平变化参与了初诊断T2DM患者发生胰岛素抵抗的病理过程。
Objective To explore the relationship between the changes of serum P-selectin and glucagon-like peptide-1(GLP-1) and insulin resistance in newly diagnosed type 2 diabetes mellitus(T2 DM). Methods Sixty newly diagnosed patients with type 2 diabetes(group A),60 patients with type 2 diabetes mellitus(group B) and 60 healthy subjects were selected as group C.Serum sP-selectin,GLP-1,fasting insulin(FINS),fasting blood glucose(FPG),insulin resistance index(HOMA-IR),glycosylated hemoglobin(HbA1 c),insulin sensitivity index(ISI) of the three groups were compared. The correlation of serum sP-selectin and GLP-1 with HOMA-IR and ISI was analyzed. Results The serum sP-selectin of group B was significantly higher than that of group A and group C(P < 0.05). The serum GLP-1 of group B was significantly lower than that of group A and group C(P < 0.05). The serum sP-selectin of group A was significant. Compared with group C(P < 0.05),serum GLP-1 in group A was significantly lower than group C(P < 0.05);HOMA-IR,HbA1 c,FINS and FPG in group A were significantly higher than group C(P < 0.05). The ISI of group A was lower than that of group C(P < 0.05). The serum sP-selectin of patients with initial diagnosis of T2 DM was positively correlated with HOMA-IR(P < 0.05) and negatively correlated with ISI(P < 0.05). Serum GLP-1 was negatively correlated with HOMA-IR in patients with T2 DM(P < 0.05) and positively correlated with ISI(P < 0.05). Serum sP-selectin,WC,disease duration,elevated BMI and decreased GLP-1 in patients with initial diagnosis of T2 DM will increase the risk of HOMA-IR in patients(P <0.05). Serum sP-selectin,WC in patients with initial diagnosis of T2 DM Increased disease duration and decreased GLP-1 increased the risk of ISI reduction in patients(P < 0.05). Conclusion Serum levels of sP-selectin and GLP-1 are involved in the pathogenesis of insulin resistance in newly diagnosed patients with T2 DM.
Objective To explore the relationship between the changes of serum P-selectin and glucagon-like peptide-1(GLP-1) and insulin resistance in newly diagnosed type 2 diabetes mellitus(T2 DM). Methods Sixty newly diagnosed patients with type 2 diabetes(group A),60 patients with type 2 diabetes mellitus(group B) and 60 healthy subjects were selected as group C.Serum sP-selectin,GLP-1,fasting insulin(FINS),fasting blood glucose(FPG),insulin resistance index(HOMA-IR),glycosylated hemoglobin(HbA1 c),insulin sensitivity index(ISI) of the three groups were compared. The correlation of serum sP-selectin and GLP-1 with HOMA-IR and ISI was analyzed. Results The serum sP-selectin of group B was significantly higher than that of group A and group C(P < 0.05). The serum GLP-1 of group B was significantly lower than that of group A and group C(P < 0.05). The serum sP-selectin of group A was significant. Compared with group C(P < 0.05),serum GLP-1 in group A was significantly lower than group C(P < 0.05);HOMA-IR,HbA1 c,FINS and FPG in group A were significantly higher than group C(P < 0.05). The ISI of group A was lower than that of group C(P < 0.05). The serum sP-selectin of patients with initial diagnosis of T2 DM was positively correlated with HOMA-IR(P < 0.05) and negatively correlated with ISI(P < 0.05). Serum GLP-1 was negatively correlated with HOMA-IR in patients with T2 DM(P < 0.05) and positively correlated with ISI(P < 0.05). Serum sP-selectin,WC,disease duration,elevated BMI and decreased GLP-1 in patients with initial diagnosis of T2 DM will increase the risk of HOMA-IR in patients(P <0.05). Serum sP-selectin,WC in patients with initial diagnosis of T2 DM Increased disease duration and decreased GLP-1 increased the risk of ISI reduction in patients(P < 0.05). Conclusion Serum levels of sP-selectin and GLP-1 are involved in the pathogenesis of insulin resistance in newly diagnosed patients with T2 DM.
引文
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[2]Chen H,Chung C,Lu C,et al.Metformin decreases the risk of sudden sensorineural hearing loss in patients with diabetes mellitus:A 14-year follow-up study[J].Diab Vasc Dis Res,2019,28(6):685-687.
[3]苏菲亚,王静.2型糖尿病合并急性脑梗死患者血清P-选择素水平及血栓弹力图指标的变化[J].山东医药,2018,58(1):75-77.
[4]盖克克,段蓉,李正翔.胰高血糖素样肽-1受体激动剂和二肽基肽酶-4抑制剂联用二甲双胍治疗2型糖尿病的疗效与安全性对比的系统评价[J].中国医院药学杂志,2017,37(7):633-638.
[5]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2013年版)[J].中国糖尿病杂志,2014,6(8):I2-I42.
[6]李悦,熊再道,徐丽梅.胰岛素与口服降糖药治疗初诊T2DM患者疗效的Meta分析[J].医学临床研究,2017,34(8):1511-1517.
[7]Bourne JE,Ivanova E,Gainforth HL,et al.Mapping behavior change techniques to characterize a social cognitive theory informed physical activity intervention for adults at risk of type 2diabetes mellitus[J].Transl Behav Med,2019,34(5):34-36.
[8]Pothof AB,O'Donnell TFX,Swerdlow NJ,et al.Risk of insulindependent diabetes mellitus in patients undergoing carotid endarterectomy[J].J Vasc Surg,2018,38(6):103-106.
[9]季小琳,罗镧,孙诚,等.老年2型糖尿病患者血清胱抑素C水平与胰岛素抵抗的相关性研究[J].中华老年医学杂志,2017,36(6):660-664.
[10]邢娜,王富军,齐会卿,等.sCD40L及sP选择素在糖尿病下肢动脉病变介入治疗前后的变化及其意义[J].中国介入影像与治疗学,2016,13(9):535-539.
[11]林震宇,匡洪宇.胰高血糖素样肽-1预防糖尿病并发症研究进展[J].中华实用诊断与治疗杂志,2018,32(1):98-100.
[12]田爱荣,田晨光.p-选择素及瘦素与2型糖尿病及大血管病变的相关性[J].中华实用诊断与治疗杂志,2016,30(7):687-689.
[13]刘艳秋,高美华,李红林,等.糖尿病及糖尿病并发冠心病患者血清sP-selectin、sE-selectin水平变化及意义[J].中国免疫学杂志,2015,31(9):1245-1249.
[14]余海英,朱素君,梁珊瑚,等.妊娠期糖尿病患者血清胰高血糖素样肽-1水平及意义[J].中国临床研究,2015,28(11):1455-1456.
[15]金兴倩,李强.胰高血糖素样肽1与糖尿病微血管病变[J].中华糖尿病杂志,2015,7(11):712-714.