肥胖合并黑棘皮病患者胰岛素分泌特征与血清成纤维细胞生长因子21的相关性

目的 探讨肥胖合并黑棘皮病患者中成纤维细胞生长因子21(FGF21)的表达及其与胰岛素分泌特征的关系.方法 选取肥胖合并黑棘皮病患者38例和单纯性肥胖患者35例,以及年龄匹配的正常对照组20例.分别检测各组炎症指标(游离脂肪酸、尿酸、C-反应蛋白)、糖脂代谢指标和胰岛素水平,并采用ELISA法测定血清FGF21水平.结果 肥胖合并黑棘皮病患者组表现为高胰岛素血症和胰岛素抵抗,血清FGF21、空腹胰岛素和胰岛素抵抗指数(HOMA-IR)高于其他两组(P＜0.05,P＜0.01),胰岛素作用指数(IAI)低于其他两组(P＜0.01).相关性分析显示肥胖患者血清FGF21水平与空腹胰岛素及HOMA-IR正相关(r=0.410,P=0.009;r=0.350,P=0.027),与IAI和体脂率呈负相关(r=-0.615,P＜0.001;r=-0.554,P＜0.001).Logistic回归分析显示尿酸水平升高和FGF21升高是肥胖患者合并黑棘皮病的独立危险因素(P=0.008,P=0.020).结论 肥胖合并黑棘皮病患者在临床上表现为高胰岛素血症和高FGF21水平.FGF21升高与胰岛素抵抗明显相关,而黑棘皮病患者的糖耐量受损较无黑棘皮病的肥胖症患者低,提示FGF21的升高可能对糖代谢有一定保护作用.尿酸和FGF21升高是肥胖症患者合并黑棘皮病的独立危险因素.

Relationship between serum fibroblast growth factor 21 and insulin secretion in obese patients with acanthosis nigricans

Fibroblast growth factor21 plays an important role in metabolic disorders, such as obesity, non-alcoholic fatty liver disease(NAFLD), insulin resistance and type2 diabetes. In this study, we aim to investigate its effects in simple obesity patients and obesity with acanthosis nigricants. Methods: 40 obesity patients (OB group) and 40 obesity with acanthosis nigricants patients (AN group) visiting our department, and 20 age-matched healthy volunteers (control group) were included in this study. Lipid profile, FFA, UA and CRP were also measured. Glucose tolerance test with the secretion of insulin in five points were performed in all participants. Serum FGF21 level was measured by ELISA. Results: The level of fasting insulin and HOMA-IR of AN were higher than OB and CON. The level of IAI of AN was lower than OB and CON (p<0.01).The difference of FGF21 between the three groups is significant (P<0.001). The serum FGF21 level was most positively correlated with fasting insulin and HOMA-IR. Conclusion: AN was the symbol of obesity and severe insulin resistance,and was closely associated with high serum level FGF21 and hyperinsulinemia. Since AN had lower serum levels of glucose than simple obesity patients, may suggest that FGF21 can benefit protective effect to glycometabolism.