血清纤溶酶原激活物抑制物-1水平与2型糖尿病合并超重或肥胖病人的血管并发症的相关性研究
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摘要
目的:通过观察2型糖尿病(T2 DM)合并超重或肥胖病人血清纤溶酶原激活物抑制物-1(PAI-1)水平变化,同时观察糖脂代谢相关指标、脂肪细胞分泌的炎症因子的变化,并与PAI-1作相关分析,探讨2型糖尿病合并超重或肥胖病人PAI-1水平的变化。方法:选取健康体检者36例作为正常对照组(NC组),将实验组分为2型糖尿病组(T2 DM组) 54例,超重或肥胖组35例,2型糖尿病合并超重或肥胖组(T2 DM+肥胖组) 48例,观察并比较各组间糖脂代谢相关指标,空腹血糖(FBG)、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL)、糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)、胰岛素抵抗指数(IR)、体重指数(BMI),及炎症相关因子,白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)及PAI-1水平,并与PAI-1做相关分析。结果:(1)与NC组比较,T2 DM组FBG、HbA1c、FINS、IR升高,差异有统计学意义,TG、TC、LDL、BMI差异无统计学意义;超重或肥胖组FINS、IR、TG、LDL、TC、BMI升高,差异有统计学意义,FBG、HbA1c差异无统计学意义; T2 DM+超重或肥胖组FBG、HbA1c、FINS、IR、TG、LDL、TC、BMI升高,差异有统计学意义。与T2 DM组比较,超重或肥胖组TG、TC、LDL、BMI升高,差异有统计学意义,FBG、HbA1c、FINS、IR降低,差异有统计学意义; T2 DM+超重或肥胖组FINS、IR、TG、TC、LDL、BMI升高,差异有统计学意义,FBG、HbA1c、差异无统计学意义。与超重或肥胖组比较,T2 DM+超重或肥胖组FBG、FINS、IR、HbA1c、LDL升高,差异有统计学意义,TG、TC、BMI差异无统计学意义。(2)与NC组比较,T2 DM组、超重或肥胖组及T2 DM+超重或肥胖组IL-6、TNF-α、PAI-1升高,差异有统计学意义。与T2 DM组比较,超重或肥胖组IL-6、TNF-α升高,差异有统计学意义,PAI-1差异无统计学意义; T2 DM+超重或肥胖组IL-6、TNF-α、PAI-1升高,差异有统计学意义。与超重或肥胖组比较,T2 DM+超重或肥胖组IL-6、TNF-α差异无统计学意义; PAI-1升高,差异有统计学意义。(3)多因素Logistic回归分析显示HbA1c、IR、TG、BMI、IL-6、TNF-α与PAI-1水平呈独立相关(均P<0.05)。结论:(1) 2型糖尿病合并超重或肥胖病人较单纯2型糖尿病病人PAI-1更高,是导致血管并发症的原因之一。(2) PAI-1升高考虑与脂肪细胞分泌IL-6、TNF-α有关。
Objective:By observing the PAI-1 level change of the patients with T2 DM and overweight or obesity,at the same time observing the glucolipid metabolism related indicators,the change of the inflammation factors secreted by the fat cells,and makeing correlation analysis,reserch the relationship betwen the level of PAI-1 and type 2 diabetes with overweight or obesity.Methods:Choose healthy check-up 36 cases as normal control group(NC group),dividing into the experimental group of type 2 diabetes(T2 DM) group 54 cases of type 2 diabetes mellitus and overweight or obesity group(T2 DM + obese) 48 cases and to observe and compare the glucolipid metabolism related index(fasting blood glucose FBG,triglyceride TG,total cholesterol TC,low density lipoprotein cholesterol LDL,glycated hemoglobin HbA1c,fasting insulin FSI,insulin resistance indexIR,body weight index BMI) between groups,inflammation related factor(interleukin-6 IL-6,tumor necrosis factor TNF-α) and PAI-1 level,and make correlation analysis with PAI-1.Results:(1) Compared with NC group,T2 DM group FBG、HbA1c、FINS、IR、IL-6、TNF-α、PAI-1 were elevated,and the differences were statistically significant(all P<0.05),and there was no statistically significant difference between TG、TC、LDL and BMI.T2 DM + overweight or obesity group FBG、HbA1c、FINS、IR、TG、LDL、BMI、IL-6、TNF-α、PAI-1 were elevated,and the differences were statistically significant(all P < 0.05),and the TC difference was not statistically significant.(2) Compared with T2 DM group,T2 DM + overweight or obesity group FINS、IR、TG、LDL、BMI、IL-6、TNF-α、PAI-1 were elevated,and the differences were statistically significant(all P<0.05),and there was no statistically significant difference between FBG、HbA1c and TC.Multifactor Logistic regression analysis showed positive correlation between HbA1c、IR、TG、BMI、IL-6、TNF-α and PAI-1(all P< 0.05).Conclusion:(1) The increase of PAI-1 in type 2 diabetic patients is one of the causes of vascular complications.(2) Patients with type 2 diabetes mellitus combined with overweight or obesity were higher in PAI-1 than in patients with type 2 diabetes,which was related to the secretion of IL-6 and TNF-αin fat cells.
Objective:By observing the PAI-1 level change of the patients with T2 DM and overweight or obesity,at the same time observing the glucolipid metabolism related indicators,the change of the inflammation factors secreted by the fat cells,and makeing correlation analysis,reserch the relationship betwen the level of PAI-1 and type 2 diabetes with overweight or obesity.Methods:Choose healthy check-up 36 cases as normal control group(NC group),dividing into the experimental group of type 2 diabetes(T2 DM) group 54 cases of type 2 diabetes mellitus and overweight or obesity group(T2 DM + obese) 48 cases and to observe and compare the glucolipid metabolism related index(fasting blood glucose FBG,triglyceride TG,total cholesterol TC,low density lipoprotein cholesterol LDL,glycated hemoglobin HbA1c,fasting insulin FSI,insulin resistance indexIR,body weight index BMI) between groups,inflammation related factor(interleukin-6 IL-6,tumor necrosis factor TNF-α) and PAI-1 level,and make correlation analysis with PAI-1.Results:(1) Compared with NC group,T2 DM group FBG、HbA1c、FINS、IR、IL-6、TNF-α、PAI-1 were elevated,and the differences were statistically significant(all P<0.05),and there was no statistically significant difference between TG、TC、LDL and BMI.T2 DM + overweight or obesity group FBG、HbA1c、FINS、IR、TG、LDL、BMI、IL-6、TNF-α、PAI-1 were elevated,and the differences were statistically significant(all P < 0.05),and the TC difference was not statistically significant.(2) Compared with T2 DM group,T2 DM + overweight or obesity group FINS、IR、TG、LDL、BMI、IL-6、TNF-α、PAI-1 were elevated,and the differences were statistically significant(all P<0.05),and there was no statistically significant difference between FBG、HbA1c and TC.Multifactor Logistic regression analysis showed positive correlation between HbA1c、IR、TG、BMI、IL-6、TNF-α and PAI-1(all P< 0.05).Conclusion:(1) The increase of PAI-1 in type 2 diabetic patients is one of the causes of vascular complications.(2) Patients with type 2 diabetes mellitus combined with overweight or obesity were higher in PAI-1 than in patients with type 2 diabetes,which was related to the secretion of IL-6 and TNF-αin fat cells.
引文
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[11]田功,何劲松.辛伐他汀对肿瘤坏死因子a诱导的人腹膜间皮细胞组织型纤溶酶原激活物(t-PA)和纤溶酶原激活物抑制因子(pai-1)1表达的影响[J].临床肾脏病杂志,2011;5(4):239-243
[12]Souza JR,Oliveira RT,Blotta MH,et al.Serum levels of interleukin-6(Il-6),Interleukin-18(Il-18)and C-reactive protein(crp)in patientswith type-2diabetes and acute coronary syndrome without ST-segment elevation[J].Arq Bras Cardiol,2008;90(2):86-90
[13]屈碧辉,何涛,胡敏,等.白细胞介素6水平在大鼠深静脉血栓形成中的变化[J].中国普通外科杂志,2014;23(6):765-768
[2]Yang W,Lu J,Weng J,et al.Prevalence of diabetes among men and women in china[J].N Engl J Med,2010;362(12):1090-1101
[3]Schwartz S,Fabricatore AN,Diamond A.Weight reduction in diabetes[J].Adv Exp Med Biol,2012;771:438-458
[4]Jensen MD,Ryan DH,Apovian CM,et al.2013aha/acc/tos guideline for the management of overweight and obesity in adults:a report of the american college of cardiology/american heart association task force on practice guidelines and the obesity society[J].J Am Coll Cardiol,2014;63(25):2985-3023
[5]白秀平,赵宝珍,李爱卿,等.血甘油三酯、尿酸对非酒精性脂肪性肝病病人血清肿瘤坏死因子α、白介素6及胰岛素抵抗的影响[J].胃肠病学和肝病学杂志,2012;21(10):936-938
[6]白秀平,杨艳兰,高敏,等.血甘油三酯对非酒精性脂肪性肝病病人纤溶酶元激活物抑制物1及脂联素水平的影响[J].胃肠病学和肝病学杂志,2014;23(4):435-437
[7]Shinozaki K,Hirayama A,Nishio Y,et al.Coronary endothelial dysfunction in the insulin-resistant state is linked to abnormal pteridine metabolism and vascular oxidative stress[J].J Am Coll Cardiol,2001;38(7):1821-1828
[8]Da silva RP,Kelly KB,AL rajabi A,et al.Novel insights on interactions between folate and lipid metabolism[J].Biofactors,2014;40(3):277-283
[9]Furumoto T,Fujii S,Nishihara K,et al.Maladaptive arterial remodeling with systemic hypertension associated with increased concentrations in blood of plasminogen activator inhibitor type-1(pai-1)[J].Am J Cardiol,2004;93(8):997-1001
[10]Cesari M,Pahor M,Incalzi RA.Plasminogen activator inhibitor-1(pai-1):a key factor linking fibrinolysis and age-related subclinical and clinical conditions[J].Cardiovasc Ther,2010;28(5):72-91
[11]田功,何劲松.辛伐他汀对肿瘤坏死因子a诱导的人腹膜间皮细胞组织型纤溶酶原激活物(t-PA)和纤溶酶原激活物抑制因子(pai-1)1表达的影响[J].临床肾脏病杂志,2011;5(4):239-243
[12]Souza JR,Oliveira RT,Blotta MH,et al.Serum levels of interleukin-6(Il-6),Interleukin-18(Il-18)and C-reactive protein(crp)in patientswith type-2diabetes and acute coronary syndrome without ST-segment elevation[J].Arq Bras Cardiol,2008;90(2):86-90
[13]屈碧辉,何涛,胡敏,等.白细胞介素6水平在大鼠深静脉血栓形成中的变化[J].中国普通外科杂志,2014;23(6):765-768