肥胖及2型糖尿病患者血清视黄醇结合蛋白4、脂联素与肿瘤坏死因子α水平变化及其相关性研究

目的：检测肥胖及2型糖尿病患者血清视黄醇结合蛋白（RBP4）、脂联素及肿瘤坏死因子α（TNF-α）水平变化，探讨三者的相关性。方法选择135例上海地区中国人，分为正常糖调节正常体质量（NBM-NGR）组、正常糖调节超重/肥胖（OW/OB-NGR）组、2型糖尿病正常体质量（NBM-T2DM）组及2型糖尿病伴超重/肥胖（OW/OB-T2DM）组，测定体脂、生化指标及RBP4、脂联素及TNF-α水平。结果 T2DM各亚组及OW/OB-NGR组RBP4均显著高于NBM-NGR组， OW/OB-T2DM组RBP4显著高于NBM-T2DM组；T2DM各亚组及OW/OB-NGR组脂联素均显著低于NBM-NGR组；T2DM各亚组TNF-α均显著高于NBM-NGR组及OW/OB-NGR组。Spearman相关分析显示，RBP4与脂联素呈负相关，与TNF-α呈正相关，TNF-α与脂联素呈负相关（P＜0.05或0.01）。多元逐步回归分析显示，甘油三酯及腰臀比（WHR）是血清RBP4的独立相关因素；性别、甘油三酯、糖化血红蛋白（HbA1c）及高密度脂蛋白是血清脂联素的独立相关因素；HbA1c是血清TNF-α的独立相关因素。结论 RBP4与腹内型肥胖的关系更为密切，而与血糖不相关；脂联素、TNF-α主要与糖代谢相关；RBP4与脂联素及TNF-α均相关。

Serum levels of retinol binding protein 4, adiponectin and tumor necrosis factor-alpha and their correlations in patients with obesity and type 2 diabetes mellitus

Objective To detect the serum levels of retinol binding protein 4 （RBP4）, adiponectin and tumor necrosis factor-alpha （TNF-α） in the patients with obesity and type 2 diabetes mellitus （T2DM）, and to explore their correlations. Methods A total of 135 Chinese individuals living in Shanghai area were divided into the subjects with normal glucose regulation and normal body mass （NBM-NGR）, overweight or obese subjects with normal glucose regulation （OW/OB-NGR）, T2DM with normal body mass （NBM-T2DM） and T2DM with overweight or obesity （OW/OB-T2DM）. The body fat, biochemical indices and the serum levels of RBP4, adiponectin and TNF-αwere determined. Results Serum RBP4 levels were significantly higher in the subjects with T2DM and OW/OB-NGR than in those with NBM-NGR, and also in those with OW/OB-T2DM than in those with NBM-T2DM. Serum adiponectin levels were significantly lower in those with T2DM and OW/OB-NGR than in those of NBM-NGR. Serum TNF-αlevels were significantly higher in those with T2DM than in those with NBM-NGR and OW/OB-NGR （P〈0.05 or 0.01）. Spearman analysis indicated that RBP4 was negatively correlated to adiponectin but positively to TNF-α, and TNF-αhad a negative correlation with adiponectin （P〈0.05 or 0.01）. Multiple stepwise regression analysis showed that triglycerides （TG） and waist-hip ratio （WHR） were the independent risk factors for RBP4. TG, sex, hemoglobin A1c （HbA1c） and high density lipid protein-cholesterol （HDL-C） were the independent risk factors for adiponectin. HbA1c was the independent risk factor for TNF-α. Conclusion RBP4 is closely associated with abdominal obesity, but has no correlation with blood glucose. Adiponectin and TNF-αare mainly related to glucose metabolism. RBP4 is related with adiponectin and TNF-α.