2型糖尿病家系一级亲属血清脂联素与胰岛素抵抗的关系及其临床意义

目的：探讨2型糖尿病（T2DM）家系正常糖耐量一级亲属（简称一级亲属）血清脂联素水平的变化。研究脂联素与胰岛素抵抗（IR）的关系及其临床意义。方法：收集T2DM家系45个。在排除糖尿痛和糖耐量减退的前提下，选择一级亲属为观察组（83例），先证者或其同胞的配偶为正常对照组（76例），检测所有受试者的空腹脂联素、血糖、胰岛素、胰岛素原、血脂水平。采用稳态模型法（HOMA）计算胰岛素抵抗指数（HOMA-IR）。结果：一级亲属组的脂联素显著低于正常对照组（P〈0．01），HOMA-IR显著高于正常对照组（P〈0．05）。相关分析显示脂联素与收缩压、舒张压、血糖、年龄、体重指数、HOMA-IR呈负相关（P〈0．05或P〈0．01）。多元线性逐步回归分析显示，脂联素是影响T2DM家系一级亲属IR的独立危险因素。结论：T2DM家系一级亲属在未发生糖尿病时已存在IR、低脂联素血症，脂联素可能影响T2DM家系一级亲属IR的程度。

The relationship of serum adiponectin level with insulin resistance in the first- degree relatives of type 2 diabetic families and its clinical significance

Objective To explore the change of serum adiponectin level in the first-degree relatives of type 2 diabetic families and the relationship between adiponectin and insulin resistance, to find out its clinical significance. Methods Forty-five type 2 diabetic families were recruited. The observation group comprised 83 first-degree with normal glucose tolerance (NGT). The normal control group comprised 76 NGT spouses of probands or siblings. The levels of fasting blood glucose (FBG), fasting serum insulin (FINS), fasting proinsulin (FPI), lipid and adiponectin were measured in two groups. Insulin resistance was estimated using the homeostasis assessment (HOMA). Results The level of adiponectin in the first-degree relatives was significantly lower (P< 0.01) and the HOMA-IR level in these population was significantly higher (P< 0.05) than that of normal control. Related analysis indicated that adiponectin was correlated negatively with systolic blood pressure, diastolic blood pressure, FBG, age, body mass index (BMI) and HOMA-IR (P< 0.05 or P< 0.01). Multiple stepwise regressions showed that adiponectin was independent risk factors affecting insulin resistance in the first-degree relatives. Conclusions Insulin resistance and hypoadiponectinemia have appeared before the development of diabetes in first-degree relatives of type 2 diabetes. Adiponectin may affect the IR of first-degree relatives of type 2 diabetes.