肥胖及2型糖尿病患者脂肪细胞脂肪酸结合蛋白水平及其临床意义

目的探讨血浆脂肪细胞脂肪酸结合蛋白（A—FABP）水平与肥胖类型，糖、脂代谢及胰岛素敏感性的关系。方法采用双抗体夹心ELISA法检测正常糖调节正常体重者（NW—NGR）44例，正常糖调节超重／肥胖者（OB—NGR）36例，新诊断2型糖尿病（T2DM）及其亚组2型糖尿病正常体重组（NW—T2DM）89例和2型糖尿病伴超重／肥胖组（OB—T2DM）44例空腹状态下血浆A—FABP，同时测定血脂谱、空腹胰岛素及测量体重指数（BMI）、腰围（WC）、腰臀比（WHR）和脂肪含量（Fat％）；采用HOMA—IR评价胰岛素敏感性。结果校正年龄、性别后，OB—NGR组，NW-T2DM组及OB—T2DM组血浆A—FABP高于NW—NGR组11．32（6．54—15．43）ug／L、14．60（10．35—20．10）ug/L、18．25（12．85～26．65）ugL VS9．32（3．72-14．00）ug/L，P均〈0．05]。OB—NGR组与NW-T2DM组间血浆A—FABP差异无统计学意义11．32（6．54—15．43）VS14．60（10．35—20．10）ug／L，P〉0．05]，但OB-NGR组与NW—T2DM组均低于OB—T2DM组11．32（6．54—15．43）ug／L、14．60（10．35—20．10）ug/LVS18.25（12．85～26．65）ug/L，P〈0．01]。校正年龄、性别及BMI后，血浆A—FABP与WC、WHR、FPG、TG、FINS、HOMA—IR均呈正相关（r=0．416、0．341、0．344、0．196、0．306、0．312，P〈0．01）。多元逐步回归分析示，HOMA—IR、性别、WC和年龄是血浆A—FABP主要的影响因素（P均〈0．05）。结论血浆A—FABP与腹型肥胖和胰岛素抵抗密切相关，可作为反映肥胖，特别是腹型肥胖的代谢标志物。

Clinical implications of plasma adipocyte fatty acid binding protein levels in patients with obesity and type 2 diabetes

Objective To explore the relationship between plasma A-FABP and obesity type and degree,glucose and lipid metabolism parameters and insulin sensitivity.Methods Plasma adipocyte fatty acid binding protein (A-FABP) was detected by double antibody sandwich ELISA in fasting status in subjects with normal glucose regulation and normal weight (NW-NGR,n =44),overweight or obese subjects with normal glucose regulation (OB-NGR,n =36),newly-diagnosed type 2 diabetes mellitus (T2DM) and its subgroups of T2DM with normal weight ( NW-T2DM,n =89 ) and T2D)M with overweight or obesity (OB-T2DM,n =44).And glucose,lipids,insulin levels as well as anthropometrical parameters such as body mass index ( BMI ),fat content ( Fat％ ),waist circumference (WC) and waist hip ratio (WHR) were measured.Meanwhile insulin sensitivity was assessed by HOMA-IR.Results After age and sex adjustment,plasma A-FABP levels in OB-NGR,NW-T2DM,and OB-T2DM were significantly higher than that of NW-NGR 11.32(6.54 - 15.43)μg/L,14.60(10.35 -20.10) μg/L,18.25(12.85 -26.65) μg/L vs 9.32(3.72 - 14.00) μg/L,all P ＜0.05].There was no difference in plasma A-FABP levels between OB-NGR and NW-T2DM 11.32 (6.54 - 15.43 ) vs 14.60 ( 10.35 -20.10) μg/L,P ＞ 0.05 ],but the plasma A-FABP levels in OB-NGR and NW-T2DM were significantly lower than that of OB-T2DM 11.32(6.54 - 15.43) μg/L,14.60( 10.35 -20.10) μg/L vs 18.25( 12.85 -26.65 ) μg/L,P ＜0.01 ].In a multiple stepwise regression analysis,HOMA-IR,sex,WC and age were the most significant independent determinants for plasma A-FABP concentration (all P ＜ 0.05 ).Conclusions Plasma A-FABP is strongly associated with the abdominal obesity and insulin resistance,measurement of plasma A-FABP concentrations might be useful for diagnosis of abdominal obesity and type 2 diabetics.