【作者】 翟倩倩；

【导师】 李华；

【作者基本信息】 郑州大学 ， 老年医学， 2012， 硕士

【摘要】 目的2型糖尿病以心血管疾病的患病及死亡风险增加为主要特征,相对于非2型糖尿病而言,2型糖尿病患者心血管患病风险约为其2-3倍,但对连接2型糖尿病与其心血管并发症的潜在作用机制所知有限。研究表明其病理改变是动脉粥样硬化,主要病理基础是由多因素相互协作所形成的慢性、亚临床炎症以及炎症导致的胰岛素抵抗。血浆网膜素-1(Omentin-1)是新近发现的一个脂肪细胞因子,研究发现其与胰岛素抵抗、糖尿病、动脉粥样硬化、肥胖等关系密切。本研究通过检测不同组别患者的血浆网膜素-1(Omentin-1)水平,分析血浆Omentin-1水平与BMI、血压、糖脂代谢指标、hsCRP、IL-6水平间的关系,探讨血浆Omentin-1与2型糖尿病并发冠心病的关系,为临床合理防治2型糖尿病及其心血管并发症提供新的思路。研究对象和方法选取2010年5月至2011年8月郑州大学第一附属医院老年内分泌科住院的70例2型糖尿病患者,按照是否伴有冠心病分为单纯2型糖尿病组36例(T2DM组)、2型糖尿病合并冠心病组34例(T2DM+CHD组)。另选取性别及年龄相匹配的29例单纯冠心病患者(CHD组)及39例健康体检者为健康对照组(HC组)。四组均统计性别、年龄、收缩压(SBP)、舒张压(DBP)、BMI、空腹血糖(FBG)、糖化血红蛋白(HbAlc)、血清空腹胰岛素(Fins)、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)、高敏C反应蛋白(hsCRP)水平,计算LDL-C/HDL-C,并用稳态模型计算胰岛素抵抗指数HOMA-IR。同时采用酶联免疫吸附法(ELISA)测定血浆Omentin-1、IL-6水平。应用SPSS17.0软件进行数据处理,检验数据的正态性及方差齐性,组间比较采用单因素方差分析。Omentin-1与其他指标的相关性应用Pearson相关分析、stepwise逐步回归分析,以P<0.05为具有统计学意义。结果1.CHD组、T2DM组及T2DM+CHD组患者血浆Omentin-1水平明显低于HC组(P<0.05)。T2DM+CHD组患者血浆Omentin-1水平明显低于CHD组(392.97±9.97vs2017.33±8.86,P<0.01)。2. Omentin-1与BMI、SBP、DBP、HbAlc、HOMA-IR、TG、LDL-C/HDL-C、 IL-6呈负相关(P<0.05)。3. BMI、HOMA-IR、IL-6是影响血浆Omentin-1的独立危险因素(P=0.043、P=0.016、P=0.003)。结论1.血浆Omentin-1的降低可能参与了2型糖尿病、冠心病特别是2型糖尿病并发冠状动脉粥样硬化的发生发展过程。2.血浆Omentin-1可能通过改善胰岛素抵抗、发挥抗炎作用、保护血管内皮功能、调节糖脂代谢等机制参与了2型糖尿病及其冠状动脉粥样硬化的发生及发展过程。3. BMI、HOMA-IR、IL-6成为影响血浆Omentin-1水平最为显著的因素。提高血浆Omentin-1水平可能有助于预防2型糖尿病及其心血管并发症的发生。更多还原

【Abstract】 Background and objectiveDiabetes has reached pandemic proportions and is associated with serious cardio-metabolic sequelae. It is well known that T2DM is closely linked to obesity, insulin resistance, and inflammation. Subjects with T2DM also have increased cardiovascular morbidity and mortality. A historical cohort study spanning over a22-year period reported that compared with non-diabetic controls, patients with T2DM showed higher cardiovascular morbidity and higher cardiovascular mortality. Adipokines contribute directly to the atherosclerotic process, connecting metabolic disorders such as obesity and diabetes to cardiovascular disease. Omentin-1is a novel adipokine, the data about the relationship of this adipikine to vascularhealth in type2diabetes is limited. Our study is to investigate the level of plasma omentin-1and other clinical data, and to analyze the distinction between type2diabetes mellitus with coronary heart disease, type2diabetes mellitus, coronary heart disease and normal controls.Research subjects and methodsA total of seventy patients with type2diabetes were divided into two groups: thirty-four patients with coronary heart disease (T2DM+CHD) and thirty-six patients without coronary heart disease (T2DM). They are from the inpatients of Geriatrics of the First Affiliated Hospital of Zhengzhou University from May2010to August2011. They are in line with1999WHO classification and diagnosis standards of diabetes. Another thirty-nine healthy control subjects (HC) and twenty-nine patients with coronary heart disease (CHD) were enrolled in this study. Plasma level of omentin-1were measured by enzyme-linked immunosorbent assay (ELISA), and other clinical markers were also measured. We analyzed the change tendency and influential factors of omentin-1in those control subjects. All the statistical analysis were dealt with SPSS17.0software.Results1. Plasma omentin-1level were found significantly decreased in patients with type2diabetes (1164.33±9.67ng/L)、patients with coronary heart disease(2017.33±8.86ng/L) and patients with type2diabetes and coronary heart disease (392.97±9.97ng/L) compared with healthy control (5764.23±9.62ng/L) at P<0.05or P<0.01.2. Plasma omentin-1level correlated negatively with BMI、SBP、DBP、HbA1c、 HOMA-IR、TG、LDL-C/HDL-C and IL-6(P<0.05).3. Multiple regression analysis showed that BMI、HOMA-IR and IL-6were the independent related factors influencing omentin-1level(P=0.043、P=0.016、P=0.003).Conclusion1. Plasma omentin-1level obviously decreased in patients with type2diabetes、 patients with coronary heart disease and patients with type2diabetes with coronary heart disease compared with healthy control. The findings suggest that omentin-1may associated with type2diabetes, coronary heart disease and type2diabetes complicated coronary atherosclerosis.2. Plasma omentin-1level correlated negatively with BMI、SBPI、DBP、HbA1c、 HOMA-IR、TG、LDL-C/HDL-C、IL-6, indicating that omentin-1may play predominant roles as anti-inflammatory molecule, regulator of insulin-resistant and protector of vascular endothelial cell. Omentin-1may link to glucose and lipid metabolism and blood pressure, and it may contribute to the pathogenesis of IR and type2diabetes complicated coronary heart disease. 3. BMI、HOMA-IR、IL-6were the independent related factors in influencing the level of omentin-1. Thus, omentin-1plausibly may interact to glucose and lipid metabolism and inflammation. Thus, omentin-1may have beneficial effects on the type2diabetes and its complicated coronary heart disease, and could potentially be used as a biologic marker to those diseases.更多还原