抵抗素、C反应蛋白与早期2型糖尿病微血管病变的关系论文

　　目的 探讨2型糖尿病(T2DM)患者血浆抵抗素、血清C反应蛋白(CRP)水平与早期T2DM微血管病变的相关性。方法 选取60例临床确诊的T2DM患者，按有无微血管并发症分为微血管并发症组 (DMA组)和无微血管并发症组(NDC组)，每组30例。另选取24例同期体检的健康志愿者作为对照组(NC组)。采用双抗体夹心酶联免疫吸附试验测定3组的血浆抵抗素含量，散射免疫比浊法测定血清CRP含量，放射免疫分析法测定胰岛素，氧化酶法测定血糖，全自动生化分析仪检测血脂。结果 ①DMA组血浆抵抗素、血清CRP含量均高于NDC组及NC组，差异有统计学意义(P<0.05)。②Pearson(或Spearman)相关分析显示，血浆抵抗素与空腹胰岛素(FIns)、糖化血红蛋白(HbA1c)、胰岛素抵抗指数(HOMA-IR)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)呈正相关(r分别为0.582、0.433、0.435、0.342、0.485，P均<0.05)，与空腹血浆葡萄糖(FPG)、甘油三酯(TG)、体质指数(BMI)、高密度脂蛋白胆固醇(HDL-C)均无相关性；血清CRP与尿微量白蛋白(UALb)、血浆抵抗素、HOMA-IR、FIns、HbA1c呈正相关(r分别为0.388、0.240、0.283、0.279、0.318，P均<0.05)，与HDL-C呈负相关(r=-0.235，P<0.05)。结论 血浆抵抗素、血清CRP可能与2型糖尿病微血管病变的发生、发展有密切关系
　　
　　ABSTRACT: Objective To investigate the relationship between plasma resistin and serum C-reactive protein (CRP) levels, with early microangiopathy in patients with type 2 diabetes mellitus (T2DM). Methods  According tomicroangiopathy, 60 patients with T2DM were divided into microangiopathy (DMA) group and non- complication (NDC) group. There were 24 healthy persons in the control group (NC). Enzyme-linked immunosorbent assay was used to determine the content of resistin, immunoturbidimetric method was used to determine the content of CRP, radio immunoassary was used to determine the content of insulin, oxydase was used to determine the content of fasting plasma glucose, and automatic analytical instrument was used to determine blood fat on the 84 subjects. Results  ① Compared with those in NDC group and NC group, the levels of plasma resistin and serum CRP were significantly increased in DMA group (P<0.05). ② In the 60 cases of T2DM, resistin level was positively correlated with FIns, HbA1c, HOMA-IR, TC, and LDL-C (r=0.582, 0.433, 0.435, 0.342, 0.485, respectively, P<0.05); resistin level had no correlation with FPG, TG, BMI or HDL-C CRP level was positively correlated with UALb, resistin, HOMA-IR, FIns, and HbA1c (r=0.388, 0.240, 0.283, 0.279, 0.318, 0.024, respectively P<0.05) but negatively correlated with HDL-C (r=-0.235, P=0.045). Conclusion  The present study shows plasma resistin and serum CRP may play an important role in the occurrance and development of microangiopathic in type 2 diabetic mellitus.
　　
　　KEY WORDS: resistin; type 2 diabetes mellitus; changes microangiopathy; C-reactive protein
　　
　　抵抗素是一种血浆蛋白，富含半胱氨酸和丝氨酸，属于抵抗素样分子(resistin like molecules, RELMs)家族［1］，在齿啮类可诱发胰岛素抵抗(IR)。研究显示，在肥胖及存在IR的齿啮类和人的循环血中抵抗素水平均升高［2-3］。Reilly等［4］的研究发现，血浆抵抗素水平与炎症标记物相关，可预测人类冠状动脉硬化症的发生，并独立于C-反应蛋白(CRP)，可能是代谢信号、炎症及动脉硬化之间的重要联系因子。CRP是标记亚临床炎症反应的重要介质。临床及流行病学研究均认为CRP可以很好地预测2型糖尿病(T2DM)的发生。有关抵抗素、CRP与血管病变的研究在大血管并发症方面较多，而对于其与糖尿病早期微血管病变的相关性临床研究较少。本研究通过对初诊的无并发症的T2DM患者及合并有早期糖尿病肾病(DN)、糖尿病视网膜病变(DR)Ⅰ-Ⅲ期的T2DM患者进行抵抗素、CRP含量的检测，观察抵抗素、CRP与早期T2DM微血管病变的相关性，为合理治疗及预防提供有益的参考。