2型糖尿病一级亲属血清视黄醇结合蛋白4水平及其与代谢综合征的相关性

目的 测定不同糖代谢状态的2型糖尿病(T2DM)一级亲属血清视黄醇结合蛋白4(RBP-4)水平,探讨RBP4在T2DM和代谢综合征(MS)发病中的作用及检测的意义.方法 收集既往无糖尿病史的T2DM一级亲属糖耐量正常(NGT)组174例、空腹血糖受损(IFG)或糖耐量低减(IGT)组55例,以及新发T2DM 71例,无糖尿病家族史的NGT 114名作为正常对照组(NC).放射免疫法测定血清RBP-4.用稳态模型指数(HOMA-IR)评价胰岛素抵抗状态.根据2005年国际糖尿病联盟共识诊断MS.结果 (1)NC、NGT、IFG/IGT和T2DM组,血清RBP-4水平分别为(18±7)μg/ml、(22±8)μg/ml、(24±9)μg/ml和(26±9)μg/ml,与无家族史的NC相比,一级亲属NGT组血清RBP-4明显增加[(18±7)μg/ml比(22±8)μg/ml,P<0.05],并随糖调节异常程度的加重RBP-4水平进一步增加,但T2DM组与IGT/IFG组相比[(26±9)μg/ml比(24±9)μg/ml]差异无统计学意义.(2)以RBP-4水平四分位值分组(Q1～Q4)比较:高浓度血清RBP-4水平不仅与糖调节异常密切相关(Q4/Q1 OR值为5.26),而且与高血压(OR:1.96)、血脂异常(OR:4.14)和肥胖(OR:2.18)以及MS(OR:4.30)相关.结论 (1)T2DM一级亲属在糖耐量异常发生前,RBP-4水平明显升高,并随糖调节异常程度加重而进一步升高,提示RBP-4与T2DM的早期发病进程密切相关;(2)RBP-4与代谢综合征关系密切.

Serum levels of retinol-binding protein-4 and its association with metabolic syndrome in first-degree relatives of type 2 diabetes mellitus

Objective To evaluate serum levels of retinol-binding protein-4 (RBP-4) in firstdegree relatives (FDR) of type 2 diabetes mellitus (T2DM) with different glucose tolerance status and to observe its correlation to metabolic syndrome (MS).Methods Subjects from FDR of T2DM,including 174 with NGT,55 with IGT/IFG,and 71 patients with newly diagnosed of T2DM and 114 subjects without diabetic family history as control group [(18±7) μg/ml vs (22±8)μg/ml,(NC) [(18±7) μg/ml vs (22±8)μg/ml,were recruited.Serum RBP-4 level was measured by radioimmunoassay.Insulin resistance was evaluated by the homeostasis model assessment (HOMA-IR).MS was diagnosed according to 2005 IDF consensus.Results (1) Serum RBP-4 levels in NC,NGT,IFG/IGT and T2DM groups were (18±7),(22±8),(24±9) and (26±9) μg/ml respectively.Serum RBP-4 was significantly elevated in NGT group of diabetic FDR as compared with NC group [(26±9) μg/ml vs (24±9) μg/ml],and increased with the severity of glucose intolerance.However,no difference was found between serum RBP-4 in the IFG/IGT and T2DM groups.(2) When the distribution of RBP-4 was stratified into quartiles (Q1-Q4),subjects in the top quartile (Q4) was not only associated with greater risk for impaired glucose regulation as compared with Q1 OR =5.26),but also significantly with risk for hypertension (OR=1.96),dyslipidemia (OR=4.14),obesity (OR = 2.18) and MS (OR = 4.30).Conclusion (1) Serum RBP-4 levels in FDR of T2 DM were elevated significantly even before the development of impaired glucose regulation and were further increased with severity of glucose tolerance,suggesting a possible role of RBP-4 in the early pathogenesis of T2DM.(2)Serum RBP-4 level was closely related to MS.