摘要目的 检测不同糖耐量人群血清adipsin水平,并探讨其与胰岛β细胞功能及胰岛素抵抗的关系.方法 选取2015年12月至2016年10月重庆医科大学附属第一医院内分泌科及体检中心就诊者共137例,其中新诊断2型糖尿病(T2DM)患者56例(T2DM组),糖调节受损(IGR)组36例,正常糖耐量者(NGT)组45例.所有研究对象均行静脉葡萄糖耐量试验(IVGTT),计算急性胰岛素分泌反应(AIR)、第一时相(0～10 min)胰岛素分泌曲线下面积(AUC)、稳态模型评估β细胞功能指数(HOMA-β)及稳态模型评估胰岛素抵抗指数(HOMA-IR),酶联免疫吸附试验法检测血清adipsin、白细胞介素1β(IL-1β)水平.探讨adipsin与AIR、AUC、HOMA-β、HOMA-IR及相关代谢指标之间的关系.正态分布资料组间比较采用单因素方差分析,非正态分布资料组间比较采用非参数检验.双变量分析采用Pearson相关分析,多因素分析采用多元逐步回归分析.结果 T2DM组和IGR组的血清adipsin浓度显著低于NGT组[3201(2542～4070)、5159(2775～6501)比6833(5587～10126)μg/L,H=24.372,P<0.05];adipsin与腰臀比、游离脂肪酸、空腹血糖、2 h空腹血糖、糖化血红蛋白、HOMA-IR、IL-1β、超敏C反应蛋白之间呈负相关(r=-0.532～-0.285,均P<0.05),而与HOMA-β、高密度脂蛋白胆固醇、AUC、AIR呈正相关(r=0.325～0.577,均P<0.05);多元逐步回归分析显示,HOMA-β和AIR是血清adipsin的独立影响因素(βHOMA-β=0.332,P=0.038;βAIR=0.349,P=0.029).结论 Adipsin在T2DM及IGR个体血清中显著降低,并且与糖脂代谢紊乱密切相关;adipsin与第一时相胰岛素分泌功能密切相关,并可能经此参与T2DM的发生发展.

abstractsObjective To investigate the serum adipsin concentrations in people with different glucose tolerance and analyze its correlation with pancreatic β cell function as well as insulin resistance. Methods Based on the patient population who visited endocrinology deptartment or conducted health check in the First Afflicated Hospital of Chongqing Medical University from December 2015 to October 2016, 56 patients with newly diagnosed type 2 diabetes mellitus (T2DM group), 36 patients with impaired glucose regulation (IGR group), and 45 subjects with normal glucose tolerance (NGT group) were included. All subjects underwent intravenous glucose tolerance test (IVGTT). Acute insulin response (AIR), the area under the curve (AUC) of 0-10 min insulin secretion, homeostasis model assessments of insulin resistance index (HOMA-IR) andβ-cell function index (HOMA-β) were calculated. Serum adipsin and interleukin-1β(IL-1β) were assayed by enzyme linked immunosorbent assay. The relationship between adipsin, AIR, AUC, HOMA-β, HOMA-IR and other metabolic parameters were analyzed. One-way analysis of variance (ANOVA) or nonparametric test were used for groups' comparisons. Pearson correlation analysis was used to determine simple bivariate relationships. Stepwise multiple regression analysis was conducted for adipsin as a dependent variable, including all variables of interest at the same time as independent variables. Results The levels of serum adipsin in T2DM group and IGR group were significantly decreased [3201 (2542-4070), 5159 (2775-6501) vs 6833 (5587-10126) μg/L, H=24.372, P<0.05]. Serum adipsin levels were negatively correlated with WHR, FFA, FPG, 2hPG, HbA1c, HOMA-IR, IL-1β, hs-CRP (r=-0.521--0.285, all P<0.05 ), and were positively correlated with HOMA-β, HDL-C, AUC, AIR (r=0.325-0.577, all P<0.05). Multiple stepwise regression analysis showed that HOMA-β and AIR were independently associated with adipsin (βHOMA-β =0.332, P=0.038; βAIR=0.349, P=0.029). Conclusions Serum adipsin concentrations are decreased in T2DM and IGR, and are closely correlated with first-phase insulin secretion. Adipsin might involve in the development of type 2 diabetes mellitus.