2型糖尿病合并痛风患者胰岛素抵抗与红细胞膜胰岛素受体的关系

目的 探讨2型糖尿病(T2DM)合并痛风患者胰岛素抵抗(IR)与红细胞膜胰岛素受体之间的关系。方法 30例T2DM合并痛风患者(T2DM Gout)、30例无痛风的T2DM患者、30例痛风患者(Gout)、26名正常人作对照(NC)，进行空腹血糖(FPG)、胰岛素(Fins)及口服葡萄糖耐量试验(OGTT)后2h血糖(2hPG)、胰岛素(2hlns)及胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、血尿酸(UA)的测定，同时检测高、低亲和力红细胞膜胰岛素受体数目(R1、R2)和高、低亲和力常数(K1、K2)，并以稳态模型(HOMA)计算胰岛素抵抗指数(HOMA-IR)为应变量，Fins、年龄、体质指数(BMI)、TG、TC、LDI～HDL、收缩压(SBP)、舒张压(DBP)、UA、R1、R2、K1、K2为自变量，进行多元逐步回归分析，分析T2DM合并痛风患者IR与红细胞膜胰岛素受体变化的关系。结果 T2DM合并痛风较无痛风的T2DM患者LDL明显升高，HDL降低，HOMA-IR显著升高，且R1、R2、K2明显减少，有统计学意义。多元逐步回归分析结果示：在α-0．05水平，进入回归方程的因素有Fins、BMI、R2、K1，有统计学意义。结论 T2DM合并痛风较无痛风的T2DM患者存在明显IR，且与红细胞膜胰岛素受体数目和亲和力密切相关。

The relationship between insulin resistance and insulin receptor on erythrocyte membrane in patients with gout and type 2 diabetes mellitus

Objective To investigate the relationship between insulin resistance and insulin receptors on erythrocyte membrane in patient s with type 2 diabetes mellitus and gout. Methods The levels of glucose and insulin at fasting and 2 hours OGTT, TC, TG, HDL, LDL, UA and i nsulin receptor number and its binding affinity on erythrocyte were determin ed in patients groups of DM gout, DM, gout, and 26 control subjects. A multipl e stepwise regression analysis was used on HOMA-IR as the dependent variabl e, and the levels of FIns, age, BMI, TG, TC, LDL, HDL, SBP, DBP, UA, R 1, R 2 , K 1, K 2 as the independent variables. Results HDL, R 1, R 2, K 2 were significantly lower and LDL, HOMA-IR were significantly h igher in the DM gout patients than those in DM patients. In the group of DM gout, a multiple stepwise regression analysis indicated that FIns, BMI, R 2, and K 1 were independent factors that affect HOMA-IR. Conclu sion There is higher insulin resistance in the DM gout than that i n DM.The reduction of insulin receptor numher and binding affinity may play an important role in pathogensis of insulin resistance.