2型糖尿病患者血清乳酸脱氢酶与胰岛素抵抗的相关性

目的探讨2型糖尿病(T2DM)患者血清乳酸脱氢酶(LDH)与胰岛素抵抗的相关性。方法选取2016年10月至2017年12月安徽省马鞍山市人民医院内分泌科住院的T2DM患者138例。患者入院后行口服葡萄糖耐量试验(OGTT),即清晨空腹状态下口服75 g葡萄糖,分别抽取口服葡萄糖前,口服葡萄糖后30、60、120 min静脉血,检测血糖及胰岛素水平。根据稳态模型胰岛素抵抗(HOMA-IR)指数标准将患者分为HOMA-IR<2.5组(50例)和HOMA-IR≥2.5组(88例)。收集并比较2组患者一般资料、相关生化指标、LDH及Matsuda胰岛素敏感指数(Matsuda ISI)等数据。根据LDH三分位数水平将患者分为<172 IU/L、172~197 IU/L和>197 IU/L 3个亚组,比较3个亚组胰岛β细胞功能相关指标HOMA-IR和Matsuda ISI及其他相关指标。采用SPSS 24.0统计软件进行分析。根据数据类型,组间比较采用独立样本t检验、Mann-Whitney U检验、χ2检验、单因素方差分析或Kruskal-Wallis H检验。指标相关性采用Spearman非参数相关分析。多因素logistic回归用于评估发生胰岛素抵抗的危险因素。结果与HOMA-IR<2.5组比较,HOMA-IR≥2.5组患者LDH、空腹血糖、各时间点胰岛素等显著升高,Matsuda ISI显著降低,差异有统计学意义(P<0.05)。<172 IU/L、172~197 IU/L和>197 IU/L 3个亚组中HOMA-IR≥2.5人数分别占50.00%(23/46)、52.17%(24/46)和89.13%(41/46)。随着LDH水平升高,HOMA-IR显著升高,Matsuda ISI显著降低,同时3亚组OGTT各时间点胰岛素不同,差异有统计学意义(P<0.05)。相关分析显示,LDH与HOMA-IR呈正相关(r=0.289,P<0.05),与Matsuda ISI呈负相关(r=-0.314,P<0.001)。校正年龄等相关因素后,多因素logistic回归分析显示,LDH为发生胰岛素抵抗的独立预测因素之一(OR=2.99,95%CI 1.83~4.67;P<0.001)。结论LDH与胰岛β细胞功能指标HOMA-IR及Matsuda ISI存在显著相关性,可以作为简单易行的指标来初步评估T2DM患者胰岛素抵抗的严重程度,协助调整治疗方案。

Correlation between serum lactate dehydrogenase and insulin resistance in patients with type 2 diabetes mellitus

Objective To explore the relationship between serum lactate dehydrogenase(LDH) and insulin resistance in patients with type 2 diabetes mellitus(T2 DM). Methods A total of 138 T2 DM inpatients admitted in our department from October 2016 to December 2017 were enrolled in this study. After admission, the patients received oral glucose tolerance test(OGTT), i.e. 75 g of glucose was taken orally in the early morning under fasting condition. The blood glucose and insulin levels were measured before and 30, 60 and 120 min after oral taking. According to homeostasis model assessment of insulin resistance(HOMA-IR), the patients were divided into HOMA-IR<2.5 group(n=50) and HOMA-IR≥2.5 group(n=88). Their general data, related biochemical indices, LDH and Matsuda insulin sensitivity index(ISI) were collected and compared between the 2 groups. According to LDH level, they were divided into 3 subgroups(<172, 172-197, and >197 IU/L). The related indices of β cell function(HOMA-IR and Matsuda ISI) and other indices were compared among the 3 subgroups. SPSS statistics 24.0 was used for data analysis. According to the type of data, independent sample t test, Mann-Whitney U test, Chi-square test, one-way ANOVA or Kruskal-Wallis H test was employed for the comparison in the groups. Spearman nonparametric correlation analysis was applied for index correlation. Multivariate logisticregression analysis was performed to evaluate the risk factors for insulin resistance. Results Compared with the HOMA-IR<2.5 group, the levels of LDH, fasting blood glucose, and insulin at every time point were significantly higher, while Matsuda ISI was obviously lower in the HOMA-IR≥2.5 group(all P<0.05). The percentage of the patients with HOMA-IR≥2.5 accounted for 50.00%(23/46), 52.17%(24/46) and 89.13%(41/46), respectively, in the 3 subgroups of LDH levels in order. With the increase of LDH levels, HOMA-IR was notably increased, Matsuda ISI was markedly decreased, and the insulin levels were different at different time points in the 3 subgroups(P<0.05). Correlation analysis showed that LDH was positively correlated with HOMA-IR(r=0.289,P<0.05), and negatively with Matsuda ISI(r=-0.314, P<0.001). After adjustment for age and other related factors, multivariate logistic regression analysis showed that LDH was one of the independent predictors of insulin resistance(OR=2.99, 95%CI 1.83-4.67;P<0.001). Conclusion LDH has significant correlations with HOMA-IR and Matsuda ISI, which can be used as a simple index to evaluate the severity of insulin resistance in T2 DM patients and help to adjust the treatment regimen.