胰岛素抵抗、瘦素抵抗与2型糖尿病并发冠心病的关系研究

目的探讨胰岛素抵抗、瘦素抵抗在2型糖尿病并发冠心病发生发展过程中的作用及相关性。方法入选符合纳入标准的正常对照组30例、2型糖尿病组60例、2型糖尿病合并冠心病组60例,收集所有研究对象的年龄、体重指数、腰臀比、平均动脉压、血脂、血糖等临床资料,并采用化学发光免疫分析法测定空腹血浆胰岛素,采用双抗体夹心法测定空腹血浆瘦素,以胰岛素抵抗指数评价胰岛素抵抗。应用SPSS13.0软件进行统计分析。结果胰岛素抵抗指数在2型糖尿病组和2型糖尿病合并冠心病组均较正常对照组显著升高(P<0.05),但2型糖尿病合并冠心病组与2型糖尿病组比较差异无统计学意义(P>0.05);血浆瘦素水平在2型糖尿病合并冠心病组较2型糖尿病组及正常对照组均显著升高(P<0.05),但2型糖尿病组与正常对照组比较差异无统计学意义(P>0.05)。在2型糖尿病合并冠心病组中进行Pearson相关分析显示,胰岛素抵抗指数与血糖、胰岛素呈正相关,与高密度脂蛋白胆固醇呈负相关,相关系数分别为0.300(P=0.020)、0.905(P=0.000)、-0.273(P=0.035);血浆瘦素与总胆固醇、低密度脂蛋白胆固醇呈正相关,相关系数分别为0.288(P=0.025)、0.257(P=0.047),与腰臀比、体重指数、胰岛素抵抗指数等均无相关性。Logistic逐步回归分析显示,年龄、腰臀比、脂蛋白(a)、瘦素是2型糖尿病并发冠心病的独立危险因素,高密度脂蛋白胆固醇是2型糖尿病并发冠心病的保护因素。结论胰岛素抵抗可能主要参与2型糖尿病发生发展的病理生理过程,与2型糖尿病是否并发冠心病无直接相关性,而瘦素抵抗则可能主要参与2型糖尿病患者冠心病发生发展的病理生理过程,与2型糖尿病本身的发生并无直接相关性,瘦素抵抗是2型糖尿病并发冠心病的直接独立危险因素,而胰岛素抵抗可能需要通过其他途径间接导致2型糖尿病患者冠心病的发生。

Relationship between insulin resistance, leptin resistance and type 2 diabetes with coronary heart disease

Objective To investigate the effect of both insulin resistance and leptin resistance on the occurrence and development of type 2 diabetes mellitus（T2DM）with coronary heart disease（CHD）.Methods According to the inclusion criteria,there were 30,60,60 subjects were selected as controlled group,T2DM group and T2DM with CHD group respectively.The clinical data including age,body mass index,waist to hip ratio,mean artery pressure,lipoproteins and glucose were collected for analysis.Fasting insulin was detected by chemiluminescent immunoassay and fasting plasma leptin was detected by enzyme-linked immunosorbent assay,insulin resistance were evaluated with the insulin resistance index.All data were analyzed by SPSS 13.0 software.Results Insulin resistance index in both T2DM group and T2DM with CHD group were significantly higher than that of the controlled group（P0.05）,but no significant difference was found between T2DM group and controlled group（P0.05）,fasting plasma leptin in T2DM with CHD group were significantly higher than that of the other two groups（P0.05）,but no significant difference was found between T2DM group and controlled group（P0.05）.All parameters were evaluated with the pearson correlation coefficient analysis in T2DM with CHD group,insulin resistance index was positively correlated with glucose and insulin but negatively with high density lipoprotein cholesterol,with the correlation coefficients of 0.300（P=0.020）,0.905（P=0.000）,-0.273（P=0.035）respectively;plasma leptin was positively correlated with total cholesterol,low density lipoprotein cholesterol,with the correlation coefficients of 0.288（P=0.025）and 0.257（P=0.047）respectively,there were no correlation between leptin and waist to hip ratio,body mass index,insulin resistance index.Logistic regression analysis revealed that age,waist to hip ratio,lipoprotein（a）and leptin were the independent risk factors of T2DM with CHD,while high density lipoprotein cholesterol exerted a protective function.Conclusions Insulin resistance may be mainly involved in the T2DM,there were no direct correlation between insulin resistance and T2DM complicated by CHD,but leptin resistance may be mainly involved in the T2DM complicated by CHD,there were no direct correlation insulin resistance and T2DM.Leptin resistance was an independent risk factor of T2DM patients with CHD,however,insulin resistance involved indirectly in the T2DM with CHD.