血清脂蛋白(a)和同型半胱氨酸(HCY)与2型糖尿病胰岛素抵抗的临床研究

目的 分析血清脂蛋白(a)[Lp(a)]和同型半胱氨酸(HCY)在2型糖尿病(T2DM)中的水平,探讨它们与胰岛素抵抗(IR)之间的关系。方法选取2012年5月～2015年12月陕西省康复医院住院并确诊为T2DM的患者108例作为病例组,病例组按照有无肾病并发症分为单纯糖尿病(SDM)组48例和糖尿病肾病(DN)组60例。同期选择67例健康体检者作为正常对照组(NC组)。收集所有研究对象一般资料并采集他们的全血及血清标本,测定以下指标:糖化血红蛋白(HbA1c)、低密度脂蛋白胆固醇(LDL-C)、尿素氮(BUN)、血肌酐(SCr)、胱抑素C(CysC)、Lp(a)和HCY水平; 对SDM组和DN组的研究者同时测定空腹血糖(FPG)、空腹胰岛素(FINS)和胰岛素抵抗指数(HOMA-IR); 比较各组间上述指标的差异以及分析Lp(a)和HCY与IR间的关系。结果 ①三组间比较仅在体重上:NC组60.1±10.34 kg,SDM组67.2±11.38 kg和DN组68.8±1.35 kg,差异有统计学意义(F=0.457,P=0.035)。②NC组、SDM组、DN组三组间比较,HbA1c(F=3.421,P=0.013),LDL-C(F=2.963,P=0.041),BUN(F=4.637,P=0.031),SCr(F=2.369,P=0.024),CysC(F=3.697,P=0.011),Lp(a)(F=1.236,P=0.021),HCY(F=4.317,P=0.027),差异均有统计学意义。③SDM组FPG,FINS和HOMA-IR分别是5.99±0.94 mmol/L,61.11±28.46 pmol/L和2.93±1.97。DN组FPG,FLNS和HOMA-IR分别是9.01±2.23 mmol/L,98.56±62.14 pmol/L和4.34±2.74。两组间比较FPG,FINS,HOMA-IR(t=0.47,0.55,0.69,均P=0.024),差异均有统计学意义。④Lp(a),HCY与HOMA-IR呈正相关,相关系数分别为r=0.761,0.840; P=0.044,0.021。结论 血清Lp(a)和HCY水平在DN患者中表达增高,与IR有一定相关性,同时检测血清Lp(a)和HCY对DN的早期发现有重要意义。

Clinical Study of Serum Lipoprotein(a)and Homocysteine with Type 2 Diabetes Mellitus and Insulin Resistance

Objective To analyze the levels of serum lipoprotein(a)[Lp(a)] and homocysteine(CHY)in type 2 diabetes mellitus(T2DM)patients and todetermine the relationship between them and diabetic insulin resistance.Methods A total of 108 patients with T2DM and 50 healthy volunteers(control group)were studied.T2DM group according to the presence of kidney disease complications could be divided into simple diabetes group(SDM)in 48 patients with diabetic nephropathy(DN)group of 60 cases.Collectedpatients general data and determined two groups of glycosylated hemoglobin(HbA1c),low density lipoprotein(LDL),urea nitrogen(BUN),serum creatinine(SCr),urinary inhibition C(CysC),Lp(a)and HCY levels; Compared differences between groups and how they related to T2DM kidney disease,and the relationship between insulin resistance.Results ①Compared between three groups only the weight(NC group 60.1±10.34 kg,SDM group 67.2±11.38 kg,DN group 68.8±1.35 kg),the difference was statistically significant(F=0.457,P=0.035).②compared between the three groups,the levels ofHbA1c(F=3.421,P=0.013),LDL-C(F=2.963,P=0.041),BUN(F=4.637,P=0.031),SCr(F=2.369,P=0.024),CysC(F=3.697,P=0.011),Lp(a)(F=1.236,P=0.021),HCY(F=4.317,P=0.027)were increasedsignificantly.③FPG,FINS and HOMA-IR in SDM group were 5.99±0.94 mmol/L,61.11±28.46 pmol/L and 2.93±1.97 respectively,FPG,FINS and HOMA-IR in DNgroup were 9.01±2.23 mmol/L,98.56±62.14 pmol/L and 4.34±2.74 respectively.Compared between the two groups,FPG(t=0.47,P=0.017),FINS(t=0.55,P=0.039),HOMA-IR(t=0.69,P=0.024)differences were statistical significance.④The Lp(a),HCY were significantly positive correlation with HOMA-IR(r=0.761,P=0.044; r=0.840,P=0.021).Conclusion Lp(a)and HCY levels in serum associated with diabeticnephropathy,and insulin resistance.And the detection of serum Lp(a)and HCY has important significance for early detection of diabetic nephropathy.