本文選題：糖尿病 + 胰島素抵抗�。� 參考：《蚌埠醫(yī)學院》2017年碩士論文

【摘要】：目的:研究幽門螺桿菌(H.pylori)感染2型糖尿病(T2DM)患者對其胰島素敏感性的影響,并分析這種影響與脂聯(lián)素分泌水平變化有無相關性,進一步探討H.pylori感染是否為T2DM發(fā)生及發(fā)展的危險因素,并預期根除H.pylori治療是否可改善胰島素抵抗程度并延緩T2DM進展。方法:收集2015年12月-2016年12月期間于我院住院的新發(fā)T2DM患者136例作為研究對象,根據(jù)14C尿素呼氣試驗結果分為H.pylori+組和H.pylori-組,并記錄受試者的年齡、性別、身高、體重,測定血清空腹血糖(FPG)、空腹胰島素(FINS)、糖化血紅蛋白(HbA1c)、總膽固醇(total cholesterol,TC)、甘油三酯(triglyceride,TG)、高密度脂蛋白膽固醇(high-density lipoprotein cholesterol,HDL-C)、低密度脂蛋白膽固醇(low-density lipoprotein cholesterol,LDL-C)、脂聯(lián)素等指標,計算體質指數(shù)(BMI)及穩(wěn)態(tài)模型胰島素抵抗指數(shù)(HOMA-IR),比較兩組各項指標的差異并進行統(tǒng)計學分析,另外對可能影響研究結果的因素(年齡及BMI)進行亞組分析,根據(jù)年齡及BMI進行分組,比較各亞組間HOMA-IR及脂聯(lián)素水平有無統(tǒng)計學差異。結果:H.pylori+組和H.pylori-組間除TC、LDL-C、FINS、HOMA-IR差異有統(tǒng)計學意義(P(27)0.05),其余臨床及實驗室指標差異均無統(tǒng)計學意義(P(29)0.05),H.pylori+組患者的低密度脂蛋白膽固醇、總膽固醇、空腹胰島素及胰島素抵抗指數(shù)均較H.pylori-組偏高。亞組分析中,對年齡及BMI進行分層后,除了年齡350歲同時BMI324.0 kg/m2亞組中胰島素抵抗指數(shù)在H.pylori+組與H.pylori-組差異無統(tǒng)計學意義之外,其余各亞組H.pylori+組胰島素抵抗指數(shù)均高于H.pylori-組,且差異有統(tǒng)計學意義(P(27)0.05),而各亞組脂聯(lián)素分泌水平無統(tǒng)計學差異(P(29)0.05)。結論:H.pylori感染增加T2DM患者胰島素抵抗程度,但H.pylori感染對脂聯(lián)素分泌水平無影響,故H.pylori感染導致的高胰島素抵抗與脂聯(lián)素無相關性,針對H.pylori進行治療可能改善胰島素抵抗進而延緩T2DM發(fā)生及發(fā)展。
[Abstract]:Objective: to study the effect of H. pylori infection on insulin sensitivity in patients with type 2 diabetes mellitus (T2DM), and to analyze whether this effect is related to the level of adiponectin secretion. To further explore whether H.pylori infection is a risk factor for the occurrence and development of T2DM, and to predict whether the eradication of H.pylori treatment can improve the degree of insulin resistance and delay the progression of T2DM. Methods: 136 newly diagnosed T2DM patients who were hospitalized in our hospital from December 2015 to December 2016 were divided into H.pylori group and H.pylori- group according to 14C urea breath test results. The age, sex, height, weight of the subjects were recorded. The levels of serum fasting blood glucose (FPG), fasting insulin (Fin), glycosylated hemoglobin (HbH1), total cholesterol (TC), triglyceride-triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), low-density lipoprotein cholesterol (LDL-LDL), adiponectin, etc., were measured. Body mass index (BMI) and homeostasis model insulin resistance index (HOMA-IRI) were calculated. The differences between the two groups were compared and statistically analyzed. In addition, the factors (age and BMIs) that might influence the results of the study were subgroup and grouped according to age and BMI. HOMA-IR and adiponectin levels were compared between subgroups. Results there was significant difference in HOMA-IR between H. pylori group and H.pylori group except TCL-LDL-CnsFINSMA-IR. There was no significant difference in other clinical and laboratory indexes between two groups. There was no significant difference in low density lipoprotein cholesterol (LDL-C) and total cholesterol (TC) between the two groups, and there was no significant difference in the clinical and laboratory indexes between the two groups, and there was no significant difference between the two groups in terms of low density lipoprotein cholesterol (LDL-C) and total cholesterol (TC). Fasting insulin and insulin resistance index were higher than H.pylori- group. In the subgroup analysis, after stratification of age and BMI, the insulin resistance index of H.pylori group was higher than that of H.pylori-group, except that the insulin resistance index of BMI324.0 kg/m2 subgroup was no significant difference between H.pylori group and H.pylori- group. There was significant difference in adiponectin secretion between the two subgroups, but there was no significant difference in adiponectin secretion between the two subgroups. Conclusion the infection of H. pylori increases the degree of insulin resistance in patients with T2DM, but the level of adiponectin is not affected by H.pylori infection, so the high insulin resistance caused by H.pylori infection has no correlation with adiponectin. Treatment of H.pylori may improve insulin resistance and delay the onset and development of T2DM.
【學位授予單位】：蚌埠醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R587.1

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1 簡詠梅;李傳榮;袁俊清;孫永寧;;糖尿病與胃癌風險相關性隊列研究的meta分析[J];中華內分泌代謝雜志;2014年10期

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