初诊2型糖尿病合并代谢综合征患者颈围与胰岛素抵抗、超敏C 反应蛋白的相关性

目的: 探讨2型糖尿病(type 2 diabetes mellitus,T2DM)合并代谢综合征(metabolic syndrome,MS)患者颈围与胰岛素抵抗、血清超敏C反应蛋白(hs-CRP)的关系。方法: 选择研究对象165 例，其中对照组55例，单纯2型糖尿病组(T2DM组)55例，T2DM合并MS组(MS组) 55例。所有研究对象测量颈围，行口服葡萄糖耐量试验(OGTT)及胰岛素释放试验，并检测血脂、血清hs-CRP等相关生化指标。结果： MS组的颈围为(38.47±3.68)cm，大于正常对照组(35.17±3.09)cm及T2DM组(36.86±2.92)cm(P<0.05或P<0.01)；MS组血清hs-CRP水平为[2.77(1.19~5.55)] mg/L，显著高于正常对照组[0.40(0.18~0.98)]mg/L及T2DM组[1.74(0.81~5.33)]mg/L(P<0.01)。随着颈围水平的升高，体质量指数(BMI)、腰围、腰臀比、空腹胰岛素(FINS)、餐后2h胰岛素(PSI)、三酰甘油、胰岛素抵抗指数(HOMA-IR)及hs-CRP水平显著升高，高密度脂蛋白胆固醇(HDL-C)水平显著降低。简单相关分析显示，颈围与BMI、腰围、腰臀比、舒张压、空腹血糖、餐后2h血糖(2hPG)、FINS、 PSI、三酰甘油、低密度脂蛋白胆固醇(LDL-C)、HOMA-IR及hs-CRP呈正相关(P<0.05或P<0.01)，与HDL-C呈显著负相关(P<0.01)；Logistic回归分析显示，颈围、腰围、三酰甘油是T2DM合并MS的危险因素，HDL-C是其保护因素(P<0.01)。结论： 新诊断T2DM合并MS患者颈围明显增加，其与胰岛素抵抗、血清hs-CRP水平密切相关，颈围是T2DM合并MS的危险因素。

Association between neck circumference,insulin resistance andhighly sensitive C-reactive protein in newly diagnosed type 2 diabetes patients with metabolic syndrome

Objective: To investigate neck circumferences in patients with type 2 diabetes mellitus (T2DM) with metabolic syndrome(MS), and to study the association between neck circumference, insulin resistance and highly sensitive C-reactive protein. Methods: A total of 165 subjects were enrolled in the study, including 55 healthy subjects and 110 patients with newly diagnosed type 2 diabetes(T2DM) which were divided into T2DM group and T2DM with MS group. Oral glucose tolerance test(OGTT) and insulin releasing test were performed in all subjects, meanwhile, neck circumference, blood lipid, hs-CRP and other items were measured. Results: Compared with control group and T2DM group, the neck circumference was increased in MS group[(38.47±3.68) vs (35.17±3.09)cm, (38.47±3.68) vs (36.86±2.92)cm, P<0.05 or P<0.01, respectively]. The serum hs-CRP in MS group was higher than in normal control group and T2DM group[2.77(1.19~5.55) vs 0.40(0.18~0.98)mg/L, 2.77(1.19~5.55) vs 1.74(0.81~5.33)mg/L, P<0.01, respectively]. Subjects in the upper neck circumference fertile had higher levels of BMI, WC, WHR, FINS, PSI, TG, HOMA IR and hs CRP, while lower levels of HDL C when compared to subjects in the middle or lower neck circumference fertile(P<0.05 or P<0.01). The neck circumference was positively correlated with BMI, WC, WHR, DBP, FPG, 2hPG, FINS, PSI, TG， LDL-C, HOMA IR and hs CRP, while negatively correlated with HDL-C(P<0.05 or P<0.01). Logistic regression analysis showed that neck circumference, WC and TG were independent risk factors for T2DM with MS, while HDL-C was the protective one(P<0.01). Conclusion: Newly diagnosed type 2 diabetes mellitus patients with MS tend to have bigger neck circumference, the neck circumference was associated with insulin resistance and hs-CRP. The neck circumference was the risk factor for T2DM with MS.