血清Leptin在2型糖尿病、肥胖发病机制中的临床价值

目的：研究2型糖尿病血清Leptin与胰岛素，体脂分布和睾酮的关系。方法：对65例2型糖尿病患者及42例正常对照者用放免法测定血清Leptin及胰岛素。34例糖尿病患者进行75克葡萄糖耐量试验，32例行螺旋CT SSD技术测定体脂分布。30例男性糖尿病患者测定血清睾酮。结果：在调整了BMI（体重指数），性别后，糖尿病组与对照组血清Leptin无差异。女性血清Leptin为男性的2．3倍，餐后2小时血清Leptin较空腹下降为19．19％，代谢控制不良者（空腹血糖＞14mmol)Leptin水平较低。性别，BMI，ASF（腹部皮下脂肪）是影响血清Leptin的重要因素，Leptin浓度与体重指数，胰岛素，腹部皮下脂肪显著正相关，与睾酮负相关，结论：2型糖尿病患者无异常血清Leptin，提示Leptin并非致2型糖尿病的主要因素，代谢控制不良者有Leptin缺乏，男性较低的Leptin可能与睾酮有关，性别，体重指数，腹部皮下脂肪是影响Leptin的主要因素。

The Clinical Significance of Serum Leptin in the Pathogenesis of 2 DM and Obesity

Objective To study the relationship between serum leptin and insulin, body fat distribution and testosterone in 2-DM patients. Methods The fasting blood serum leptin and insulin levels in 65 2DM patients and 42 controls were measured by radioimmunoassay. Abdominal subcutaneous adipose tissue volume (ASF) and abdominal visceral adipose tissue volume (AVF) were measured by spiral CT SSD soft-ware in 32 2DM patients. We also measured the leptin before and 2h after a 75g OGTT in 34 2DM patients and fasting plasma testosterone in 30 2DM males. Results DM group and normal group had equal number of females and were matched in BMI. Baseline plasma leptin concentrations were not significantly different between the groups ( P >0.05). Women had leptin levels 2.3 times those of men. Leptin concentrations dropped by 19.19% ( P <0.05) 2hrs after OGTT. The patients poorly metabolicly controlled (FBG>14mmol/L) had lower leptin levels ( P <0.05). Sex, BMI, ASF were important factors contributing to the serum leptin. The leptin concentrations were significantly positively correlated with BMI ( r =0.57, P 0.0001), ASF( r =0.67 P 0.025) and insulin ( r =0.47, P 0.0013) and was negativel correlated with the serum testosterone ( r =-0.061, P 0.025). Conclusion There were no abnormal leptin levels in 2DM implies, suggesting that leptin might not be the main causing factor in 2DM. The poorly metabolicly controlled patients might have lack of leptin. The lower leptin levels in men might be caused by testosterone. sex BMI, ASF were important factors contributing to the serum leptin levels.