發(fā)布時(shí)間：2018-06-27 02:44

  本文選題：成纖維細(xì)胞生長因子21 + 2型糖尿病�。� 參考：《揚(yáng)州大學(xué)》2017年碩士論文

【摘要】：研究背景和目的成纖維細(xì)胞生長因子21(Fibroblast growth factor 21,FGF21)是新近發(fā)現(xiàn)的成纖維細(xì)胞生長因子家族中的獨(dú)特一員,它參與全身的代謝調(diào)控。FGF21在哺乳動(dòng)物包括肝臟、脂肪組織、胰腺和骨骼肌等多個(gè)組織中都有表達(dá),尤其對(duì)降低體重、增加機(jī)體胰島素敏感性具有顯著的作用。有研究發(fā)現(xiàn)FGF21與糖尿病、肥胖、高脂血癥、非酒精性脂肪性肝病(non-alcoholic fatty fiver disease,NAFLD)、代謝綜合征、多囊卵巢綜合征等多種代謝疾患有關(guān)。有研究提出FGF21水平在肥胖、2型糖尿病患者體內(nèi)增高,但其確切的作用機(jī)制尚不明確。本研究觀察在2型糖尿病合并肥胖患者體內(nèi)血清FGF21的水平,探索其是否可應(yīng)用于臨床作為糖尿病、肥胖和其他相關(guān)疾病的風(fēng)險(xiǎn)預(yù)測因子。方法選取2016年3月-2016年12月在揚(yáng)州大學(xué)附屬醫(yī)院就診的90例2型糖尿病患者以及同期本院體檢中心30例健康者。2型糖尿病組根據(jù)體重指數(shù)(BMI)分為超重和(或)肥胖組51例和正常體重組39例。記錄各組受試者的基本臨床信息及檢測實(shí)驗(yàn)室檢查結(jié)果,比較各組受試者的頸圍(NC)、腰圍(WC)、腰臀比(WHR)、總膽固醇(TC)、甘油三酯(TG)、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(HbAlc)、頸動(dòng)脈內(nèi)膜中膜厚度(CIMT)、空腹C肽(C-P)、血清FGF21水平。FGF21采用酶聯(lián)免疫法測定。采用Person相關(guān)分析FGF21的相關(guān)因素,多因素分析采用二項(xiàng)Logistic回歸模型分析2型糖尿病影響因素。結(jié)果(1)3組受檢者性別構(gòu)成、年齡、UA、TC、LDL-C無明顯統(tǒng)計(jì)學(xué)差異(P0.05),BMI、NC、WC、WHR、CIMT、FPG、HbA1c、TG、HDL-C、C肽、血清成纖維細(xì)胞生長因子21(FGF21)水平間有差異(P0.05);2型糖尿病合并超重/肥胖組患者血清FGF21水平[(663.14±397.82)pg/mL]和2型糖尿病正常體重組血清FGF21水平[(699.01±474.71)pg/mL]均高于對(duì)照組[(468.35±304.86)pg/mL]。(2)Spearman 及 Pearson 相關(guān)分析顯示,FGF21 水平與 NC、WC、WHR、TG 呈正相關(guān)(r 值分別為 0.205、0.291、0.392 和 0.233;P 值0.05 和 P0.01);NC 水平與BMI、WC、WHR、CIMT、UA、TG、C-P 呈正相關(guān)(r 值分別為 0.628、0.680、0.533、0.507、0.259、0.260 和 0.274;P0.01),與血清 HDL-C 水平呈負(fù)相關(guān)(r 值為-0.342;P0.01)(見表4);CIMT水平與性別、BMI、WC、WHR呈正相關(guān)(r值分別為0.180、0.343、0.422和0.359;P0.05和P0.01),與血清HDL-C水平呈負(fù)相關(guān)(r值為-0.216,P 值為 0.018)。(3)多因素 Logistic 回歸分析顯示,FGF21(OR =1.004,P = 0.044)、FPG(OR=40.275,P0.01)是2型糖尿病的獨(dú)立危險(xiǎn)因素。結(jié)論(1)高血清FGF21水平可能是2型糖尿病的風(fēng)險(xiǎn)預(yù)測因子之一;(2)血清FGF21水平與NC、WC、WHR、TG呈正相關(guān),提示血清FGF21升高與2型糖尿病患者肥胖、高脂血癥有關(guān);(3)2型糖尿病患者頸圍增粗,且與腰圍、腰臀比數(shù)值密切相關(guān),將來有可能替代上述2個(gè)參數(shù)成為篩查腹型肥胖的更簡易的測量指標(biāo);(4)頸圍與CIMT相關(guān),提示NC可能作為糖尿病心血管風(fēng)險(xiǎn)預(yù)測因子,對(duì)糖尿病患者進(jìn)行頸圍篩查可盡早發(fā)現(xiàn)心血管并發(fā)癥的高危人群。
[Abstract]:Background and objective Fibroblast growth factor 21 (FGF21) is a unique member of the newly discovered fibroblast growth factor family. Many tissues, such as pancreas and skeletal muscle, are expressed, especially in reducing body weight and increasing insulin sensitivity. Studies have found that FGF21 is associated with diabetes, obesity, hyperlipidemia, nonalcoholic fatty liver disease (NAFLD), metabolic syndrome, polycystic ovary syndrome and other metabolic disorders. It has been suggested that the level of FGF21 is increased in obese type 2 diabetic patients, but the exact mechanism of FGF21 level is still unclear. In this study, we observed the serum FGF21 level in patients with type 2 diabetes mellitus and obesity, and explored whether it could be used as a risk factor for diabetes, obesity and other related diseases. Methods from March 2016 to December 2016, 90 patients with type 2 diabetes mellitus and 30 healthy people from the physical examination center of Yangzhou University were divided into overweight and / or fat according to body mass index (BMI). There were 51 cases in fat group and 39 cases in normal weight group. Recording the basic clinical information and testing laboratory results of the subjects in each group, The neck circumference (NC), waist circumference (WC), waist hip ratio (WHR), total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), fasting blood glucose (FPG), glycosylated hemoglobin (HbAlc), carotid intima media thickness (CIMT) were compared. Fasting C-peptide (C-P), serum FGF21 level. FGF21 was determined by enzyme-linked immunosorbent assay (Elisa). The related factors of FGF21 were analyzed by person correlation analysis, and the influencing factors of type 2 diabetes mellitus were analyzed by multivariate logistic regression model. Results (1) there was no significant difference in LDL-C between the three groups (P0.05). There was significant difference in serum fibroblast growth factor 21 (FGF21) levels between patients with type 2 diabetes mellitus complicated with overweight / obesity [(663.14 鹵397.82) PG / mL] and normal weight group with type 2 diabetes mellitus [(699.01 鹵474.71) PG / mL] compared with control group [(468.35 鹵304.86) PG / mL]. (2) Spearman and Pearson correlation analysis. The results showed that the level of FGF21 was positively correlated with TG (r = 0.205, 0.291, P = 0.392 and 0.233, P = 0.05 and P0.01, respectively). The level of NC was positively correlated with the C-P of BMIWCU WCIMTU UAT (r = 0.6280.680, 0.5330.507U 0.259U 0.260 and 0.274P0.01, respectively), and negatively correlated with serum HDL-C (r = -0.342P 0.01) (see Table 4). CIMT level was negatively correlated with gender BMIWCWHR (r = 0.6280.680) and serum HDL-C (r = -0.342g / P0.01). (see Table 4) the level of CIMT was negatively correlated with the gender of BMIWCWHR. Positive correlation (r = 0.180 0, 0.343 鹵0.422, P 0.05 and P 0.01), and negative correlation with serum HDL-C level (r = -0.216 P = 0.018). (3) multivariate logistic regression analysis showed that FGF21 (OR 1.004 P = 0.044) FPG (OR40.275 P0.01) was an independent risk factor for type 2 diabetes mellitus. Conclusion (1) the high serum FGF21 level may be one of the risk predictors of type 2 diabetes, (2) the serum FGF21 level is positively correlated with the level of serum NCU WCU WHRG TG, which suggests that the increase of serum FGF21 level may be associated with obesity and hyperlipidemia in type 2 diabetes mellitus patients, (3) the neck circumference of type 2 diabetes mellitus patients is thickened. And it is closely related to waist circumference and waist-to-hip ratio. It is possible to replace the above two parameters as a simple measurement index for abdominal obesity in the future. (4) neck circumference is associated with CIMT, suggesting that NC may be a predictor of cardiovascular risk in diabetes mellitus. Neck screening of diabetic patients can detect cardiovascular complications as early as possible in high risk population.
【學(xué)位授予單位】：揚(yáng)州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R587.1

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