本文選題：糖代謝異常 + 老年人��； 參考：《鄭州大學》2017年碩士論文

【摘要】：目的:鳶尾素(Irisin)是最近幾年新發(fā)現(xiàn)的一種肌肉因子,研究者認為肌肉因子合成以及分泌的紊亂是導致多種代謝紊亂的機制之一[1]。鳶尾素最主要的生物學功能是通過上調(diào)白色脂肪細胞解耦聯(lián)蛋白Ⅰ(UCP1)促進白色脂肪細胞轉(zhuǎn)化為褐色脂肪細胞,這一效應被稱作“白色脂肪褐色化”[2]。白色脂肪褐色化可以使機體的新陳代謝加快、能量消耗增加,也可以調(diào)節(jié)葡萄糖代謝的平衡,起到抵制肥胖以及胰島素抵抗的作用[3]。研究發(fā)現(xiàn)[4]正常人血清鳶尾素水平顯著高于2型糖尿病(T2DM)患者的血清鳶尾素水平,并且2型糖尿病患者血清鳶尾素水平和胰島素抵抗指數(shù)(IR)呈負相關[4],鳶尾素參與了胰島素抵抗的發(fā)生及發(fā)展過程[4]。也有研究表明糖尿病腎病(DN)患者血清鳶尾素水平降低,鳶尾素可能和糖尿病腎病患者的糖脂代謝紊亂以及腎功能損傷發(fā)生的過程有關[5]。但是目前關于不同糖代謝老年人血清鳶尾素水平的比較研究尚未見報道。我們對140例不同糖代謝老年人的血清鳶尾素濃度及相關臨床指標進行了檢測和測量,探討了不同糖代謝狀態(tài)下老年人血清鳶尾素水平有無差異以及影響老年2型糖尿病患者血清鳶尾素水平的相關因素。方法:隨機選取≥60歲的老年人共140例,其中2型糖尿病組(T2DM)34例,空腹血糖受損組(IFG)34例,糖耐量減低組(IGT)36例,糖耐量正常組(NGT)36例。T2DM組的診斷采用1997年美國糖尿病協(xié)會(ADA)制定的T2DM診斷標準:出現(xiàn)糖尿病癥狀(即煩渴、多飲、多尿、難以解釋的體重減輕)+(1)一天之中有任意時間靜脈血漿葡萄糖濃度≥11.1mmol/L,或(2)空腹超過8小時后的靜脈血漿葡萄糖濃度即空腹葡萄糖(FPG)≥7.0 mmol/L,或(3)OGTT2小時的血漿葡萄糖濃度≥11.1mmol/L;空腹血漿葡萄糖濃度在6.1~6.9mmol/L為IFG組;OGTT2h血漿葡萄糖濃度在7.8~11.0mmol/L為IGT組;OGTT 2h血漿葡萄糖濃度≤7.0 mmol/L為NGT組。所有受試者均測量身高、體重、腰圍(WC)、臀圍,計算體質(zhì)指數(shù)(BMI)、腰臀比(WHR),檢測鳶尾素(Irisin)、空腹胰島素(FIns)、OGTT2h胰島素、甘油三酯(TG)、總膽固醇(TC)、低密度脂蛋白膽固醇(LDL-C)、高密度脂蛋白膽固醇(HDL-C)、空腹血糖(FPG)、糖化血紅蛋白(HbA1c)、血肌酐(Cr),估算腎小球濾過率(eGFR)。結(jié)果:1.T2DM組、IGT組、IFG組BMI、WHR、HbA1c、TC、TG、LDL-C、eGFR均明顯高于NGT組(均P0.05),OGTT2h胰島素低于NGT組(均P0.05);T2DM組、IGT組、IFG組BMI、WHR、TC、TG、LDL-C、eGFR、HbA1c、OGTT2 h胰島素相比均無明顯差異(均P0.05)。2.T2DM組、IGT組、IFG組血清鳶尾素濃度明顯低于NGT組[T2DM、IGT、IFG/NGT=(1.67±1.62)、(2.79±1.67)、(2.35±2.69)/(3.13±2.76)ng/L,F=33.24,均P㩳0.05];T2DM組血清鳶尾素濃度低于IGT組和IFG組[T2DM/IGT、IFG=(1.67±1.62)/(2.79±1.67)、(2.35±2.69)ng/L,均P㩳0.05];IGT組和IFG組之間血清鳶尾素濃度相比無明顯差異(P0.05)。3.經(jīng)Pearson相關分析,老年T2DM組血清鳶尾素濃度與年齡、身高、體重、腰圍、臀圍、空腹胰島素、OGTT2h胰島素、FPG、HDL-C、Cr無明顯相關性(均P0.05),與BMI、WHR、TC、TG、LDL-C、HbA1c呈負相關(r=-0.31、-0.29、-0.261、-0.255、-0.238、-0.352,均P0.05),與eGFR呈正相關(r=0.082,P0.05)。4.進一步經(jīng)多元線性回歸分析發(fā)現(xiàn),WHR、HbA1c是T2DM患者血清鳶尾素的主要負性影響因子(標準化回歸系數(shù)=-3.25,-1.54,均P0.05),固定HbA1c后,WHR升高是老年T2DM組血清鳶尾素濃度下降的獨立危險因素。結(jié)論:鳶尾素在NGT組、IGT組、IFG組及T2DM組患者血清中的表達呈逐漸下降趨勢,WHR、HbA1c是影響老年T2DM患者血清鳶尾素水平的重要的負性因子。
[Abstract]:Objective: irises (Irisin) is a newly discovered muscle factor in recent years. Researchers believe that the synthesis of muscle factors and the disorder of secretion are one of the mechanisms leading to a variety of metabolic disorders. The most important biological function of [1]. is the up-regulation of white adipocyte decoupling protein I (UCP1) to promote white fat cells to browning. Color adipocyte, this effect is called "white fat Brown" [2]. white fat Brown can accelerate metabolism, increase energy consumption, regulate the balance of glucose metabolism, play the role of resisting obesity and insulin resistance, [3]. research shows that the level of Irone in serum of [4] normal people is significantly higher than that of type 2 The level of iris in patients with diabetes mellitus (T2DM), and the negative correlation between the serum iririn level and the insulin resistance index (IR) in type 2 diabetes patients, iririn was involved in the development and development of insulin resistance, [4]. also showed that the level of iris in patients with diabetic nephropathy (DN) decreased, iris and diabetic kidneys were possible. The disorder of glucose and lipid metabolism and the process of renal function injury are related to [5]., but there is no report on the comparative study of the levels of iris in different glycometabolic elderly people. We have detected and measured the serum iris concentration and related clinical indexes in 140 elderly patients with different glucose metabolism, and discussed different sugars. There was no difference in serum Irone level in the elderly and related factors affecting the level of serum Irone in elderly patients with type 2 diabetes. Methods: 140 cases of elderly people aged 60 years old were randomly selected, including 34 cases of type 2 diabetes (T2DM), 34 cases of impaired fasting blood glucose (IFG), 36 cases of impaired glucose tolerance group (IGT), and normal glucose tolerance group (NGT) 3 6 cases of.T2DM were diagnosed by the 1997 American Diabetes Association (ADA) standard of T2DM diagnosis: diabetes symptoms (i. e., polydipsia, polydipsia, polyuria, unexplained weight loss) + (1) the glucose concentration of venous plasma glucose was more than 11.1mmol/L at any time of the day, or (2) the concentration of glucose in the venous plasma after more than 8 hours was empty. Glucose (FPG) was more than 7 mmol/L, or (3) OGTT2 hours of plasma glucose concentration more than 11.1mmol/L; fasting plasma glucose concentration in 6.1~6.9mmol/L was IFG group; OGTT2h plasma glucose concentration in 7.8~11.0mmol/L was IGT group; OGTT 2H plasma glucose concentration was less than 7 mmol/L. All subjects measured height, weight, waist circumference, hip circumference, Calculation of body mass index (BMI), waist to hip ratio (WHR), detection of iridin (Irisin), fasting insulin (FIns), OGTT2h insulin, triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), fasting blood glucose (FPG), glycosylated hemoglobin (HbA1c), blood creatinine (Cr), estimated glomerular filtration rate. Fruit: 1.T2DM group, IGT group, IFG group BMI, WHR, HbA1c, TC, TG, eGFR are obviously higher than NGT group (all P0.05). GT, IFG/NGT= (1.67 + 1.62), (2.79 + 1.67), (2.35 + 2.69) / (3.13 +. 2.76) ng/L, F=33.24, P? 0.05], serum iris concentration in T2DM group was lower than IGT and IFG [T2DM/IGT, IFG= (1.67 + 1.62) / (2.79 + 1.67), (2.35 + 1.67) ng/L. The serum iris concentration in the elderly T2DM group has no significant correlation with age, height, weight, waist circumference, hip circumference, fasting insulin, OGTT2h insulin, FPG, HDL-C, Cr (P0.05). It is negatively correlated with BMI, WHR, TC, TG, LDL-C. The regression analysis found that WHR and HbA1c were the main negative factors of the serum iris in T2DM patients (the normalized regression coefficient =-3.25, -1.54, P0.05). After HbA1c, the increase of WHR was an independent risk factor for the decrease of serum Irone concentration in the elderly group T2DM. Conclusion: the expression of iris in the serum of NGT, IGT, IFG and other groups was gradually Downtrend, WHR and HbA1c are important negative factors that affect serum irises in elderly T2DM patients.
【學位授予單位】：鄭州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R587.1

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