2型糖尿病患者胱抑素C與胰島素抵抗及β細(xì)胞功能的相關(guān)性研究
發(fā)布時(shí)間：2018-07-17 05:58
【摘要】：研究背景：近年來(lái),社會(huì)經(jīng)濟(jì)飛速發(fā)展,在顯著提高人民生活質(zhì)量、改變生活環(huán)境的巨同時(shí),也加速了糖尿病在全球范圍內(nèi)的廣泛流行。目前糖尿病已成為繼惡性腫瘤、心血管疾病之后的第三大嚴(yán)重威脅人類健康的代謝性疾病。2型糖尿病占總糖尿病人數(shù)的90%以上,是由遺傳因素和環(huán)境共同作用引起的一組以糖代謝紊亂為主要表現(xiàn)的臨床綜合征,胰島分泌功能減退與胰島素作用下降為其發(fā)病的主要病理生理基礎(chǔ)。胱抑素C又稱半胱氨酸蛋白酶抑制蛋白C,體內(nèi)所有有核細(xì)胞均可分泌,參與多種蛋白水解調(diào)控。已有研究證實(shí),胱抑素C可以預(yù)測(cè)糖尿病發(fā)生,并與糖尿病大血管并發(fā)癥及糖尿病微血管并發(fā)癥均密切相關(guān)。然而,胱抑素C與糖尿病人群的胰島功能及胰島素抵抗之間的關(guān)系目前仍少有文獻(xiàn)論及。研究目的：本研究以不同C肽釋放曲線下面積分別代表基礎(chǔ)胰島功能、早期時(shí)相胰島功能以及全時(shí)相胰島功能,以Homa-IR評(píng)估胰島素抵抗,Homa-S評(píng)估胰島素敏感性,分別比較在2型糖尿病人群中,胱抑素水平與胰島功能及胰島素抵抗的是否相關(guān)。方法：本研究隨機(jī)選取部分于2012年6月30日到2015年3月31日期間在山東大學(xué)齊魯醫(yī)院內(nèi)分泌科住院治療的2型糖尿病患者229例作為研究對(duì)象。其中男性117例,女性112例,平均年齡58.74±10.30歲,最大85歲,最小26歲。所有研究對(duì)象均為自愿參加,均對(duì)接受一般信息采集、體格檢查及化驗(yàn)室檢查。一般信息包括：基本信息、既往病史、家族史、是否服用藥物等。體格檢查所包括的數(shù)據(jù)有：身高、體重、腰圍。化驗(yàn)室檢查結(jié)果均為患者空腹8小時(shí)、接受胰島素治療者停用胰島素10小時(shí)以上后靜脈采血所得,包括：總膽固醇(TC)、甘油三酯(TG)、低密度脂蛋白膽固醇(LDL)、高密度脂蛋白膽固醇(HDL)、空腹血糖(FPG)、空腹胰島素(FINS)、糖化血紅蛋白(HbA1C)、胱抑素C (Cys-C)、血肌酐(Cr)、血游離脂肪酸(FFA)等。然后,口服75g葡萄糖之后分別于0.5小時(shí)、1小時(shí)、2小時(shí)、3小時(shí)留取靜脈血測(cè)該時(shí)刻血糖、胰島素及C肽。對(duì)不同胱抑素水平人群的胰島功能情況進(jìn)行比較。數(shù)據(jù)錄入采用Microsoft Office Excel2010,C肽釋放曲線下面積計(jì)算采用Graph Pad Prism5.所有數(shù)據(jù)采用SPSS 16.0軟件進(jìn)行統(tǒng)計(jì)分析。結(jié)果：1.不同水平血清胱抑素C的2型糖尿病患者組間比較顯示：隨胱抑素C水平升高,年齡、病程、BMI、SBP、血肌酐、冠心病患病率、糖尿病多種并發(fā)癥患病率、Homa2%B、 AUC2h等均逐漸增加；CCR、Homa2%S則逐漸降低；HomaIR、AUCO.5h在胱抑素C正常范圍內(nèi)隨胱抑素C水平升高而升高,在胱抑素C異常組則出現(xiàn)輕度下降。2. Logistic回歸分析顯示,胱抑素C異常是糖尿病腎病、糖尿病視網(wǎng)膜病變、糖尿病周圍神經(jīng)病變等的獨(dú)立危險(xiǎn)因素。3.校正性別、年齡、BMI、病程、血脂、吸煙史、飲酒史、白細(xì)胞以及冠心病史、血肌酐水平等因素后,血清胱抑素C水平與Homa2-IR、0.5小時(shí)C肽釋放曲線下面積(AUC 0.5h)呈線性正相關(guān)。3. Logistic回歸分析顯示,在2型糖尿病患者中,正常范圍偏高的胱抑素C、異常升高的胱抑素C均為胰島素抵抗的獨(dú)立危險(xiǎn)因素且其危險(xiǎn)度隨胱抑素C水平升高而升高。4. Logistic回歸分析顯示,在2型糖尿病患者中,胱抑素C水平不是胰島功能的獨(dú)立相關(guān)因素。結(jié)論：1.隨血清胱抑素C水平的升高,各種糖尿病并發(fā)癥發(fā)病率逐漸升高；2.血清胱抑素C升高是2型糖尿病患者胰島素抵抗的獨(dú)立危險(xiǎn)因素。3.血清胱抑素C水平與2型糖尿病患者的胰島功能情況未見相關(guān)。
[Abstract]:Research background: in recent years, the rapid development of social economy has greatly improved the quality of people's life and changed the living environment greatly. It also accelerated the widespread prevalence of diabetes in the world. At present, diabetes has become the third major serious metabolic disease of human health,.2 diabetes, after malignant tumor and cardiovascular disease. More than 90% of the total number of diabetes mellitus is a group of clinical syndromes, which are caused by the combination of genetic factors and the environment, and the main pathophysiological basis of the pancreatic islet secretory function and the decrease of insulin action. Cystatin C, also known as cystine protease inhibitor C, is all nucleated in the body. Cells can be secreted and participate in a variety of protein hydrolysis regulation. Studies have shown that cystatin C can predict the occurrence of diabetes and is closely related to diabetic macrovascular complications and diabetic microvascular complications. However, there are few literature on the relationship between cystatin C and islet function and islet resistance in diabetic people. Objective: in this study, the area under different C peptide release curves represented basic islet function, early phase islet function and full phase islet function. Insulin resistance was evaluated by Homa-IR, and Homa-S was evaluated for insulin sensitivity. The levels of cystatin and islet function and insulin resistance were compared in type 2 diabetes. Methods: This study randomly selected 229 patients with type 2 diabetes hospitalized at the Department of Endocrinology, Qilu Hospital, Shandong University from June 30, 2012 to March 31, 2015. There were 117 cases of male and 112 women, the average age was 58.74 + 10.30 years old, the oldest was 85, and the smallest was 26 years old. All the subjects were voluntary. General information collection, physical examination and laboratory examination. General information including basic information, past medical history, family history, or not. Physical examination included data included height, weight, waist circumference. The results of the laboratory were all 8 hours in the patient's empty abdomen and 10 hours of insulin treatment for discontinuation of insulin. The above venous blood collection includes: total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL), high density lipoprotein cholesterol (HDL), fasting blood glucose (FPG), fasting insulin (FINS), glycosylated hemoglobin (HbA1C), Cystin C (Cys-C), serum creatinine (Cr), and blood free fatty acid (FFA). Then, after taking orally 75g glucose Don't take 0.5 hours, 1 hours, 2 hours, 3 hours to take venous blood to measure blood sugar, insulin and C peptide. Compare the islet function of people with different cystatin levels. Data entry is Microsoft Office Excel2010, the area of C peptide release curve is calculated by Graph Pad Prism5. data using SPSS 16 software. Results: 1. patients with type 2 diabetic patients with different levels of serum cystatin C showed that with the level of cystatin C, age, course of disease, BMI, SBP, serum creatinine, coronary heart disease, the prevalence of multiple complications, Homa2%B, AUC2h and so on gradually increased; CCR, Homa2%S decreased gradually; HomaIR, AUCO.5h in cystatin was C normal The elevated levels of cystatin C and mild decrease in.2. Logistic regression analysis in the abnormality of cystatin C showed that cystatin C was an independent risk factor for diabetic nephropathy, diabetic retinopathy, and diabetic peripheral neuropathy,.3. correction of sex, age, BMI, course of disease, blood lipid, smoking history, drinking history, leukocyte With the history of coronary heart disease, serum creatinine level and other factors, the serum cystatin C level and Homa2-IR, the area under the 0.5 hour C peptide release curve (AUC 0.5h) were linear and positive correlation.3. Logistic regression analysis showed that in type 2 diabetic patients, the normal range of cystatin C and the abnormal elevated cystatin C were independent risk factors for insulin resistance. The increase in the risk of cystatin C and increased.4. Logistic regression analysis showed that cystatin C level was not an independent factor in islet function in type 2 diabetic patients. Conclusion: 1. with the increase of serum cystatin C level, the incidence of various diabetic complications is gradually increased; 2. serum cystatin C increase is type 2 diabetic patients. The independent risk factor for insulin resistance was.3. serum cystatin C level and no correlation with islet function in type 2 diabetic patients.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R587.1
本文編號(hào)：2129317
[Abstract]:Research background: in recent years, the rapid development of social economy has greatly improved the quality of people's life and changed the living environment greatly. It also accelerated the widespread prevalence of diabetes in the world. At present, diabetes has become the third major serious metabolic disease of human health,.2 diabetes, after malignant tumor and cardiovascular disease. More than 90% of the total number of diabetes mellitus is a group of clinical syndromes, which are caused by the combination of genetic factors and the environment, and the main pathophysiological basis of the pancreatic islet secretory function and the decrease of insulin action. Cystatin C, also known as cystine protease inhibitor C, is all nucleated in the body. Cells can be secreted and participate in a variety of protein hydrolysis regulation. Studies have shown that cystatin C can predict the occurrence of diabetes and is closely related to diabetic macrovascular complications and diabetic microvascular complications. However, there are few literature on the relationship between cystatin C and islet function and islet resistance in diabetic people. Objective: in this study, the area under different C peptide release curves represented basic islet function, early phase islet function and full phase islet function. Insulin resistance was evaluated by Homa-IR, and Homa-S was evaluated for insulin sensitivity. The levels of cystatin and islet function and insulin resistance were compared in type 2 diabetes. Methods: This study randomly selected 229 patients with type 2 diabetes hospitalized at the Department of Endocrinology, Qilu Hospital, Shandong University from June 30, 2012 to March 31, 2015. There were 117 cases of male and 112 women, the average age was 58.74 + 10.30 years old, the oldest was 85, and the smallest was 26 years old. All the subjects were voluntary. General information collection, physical examination and laboratory examination. General information including basic information, past medical history, family history, or not. Physical examination included data included height, weight, waist circumference. The results of the laboratory were all 8 hours in the patient's empty abdomen and 10 hours of insulin treatment for discontinuation of insulin. The above venous blood collection includes: total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL), high density lipoprotein cholesterol (HDL), fasting blood glucose (FPG), fasting insulin (FINS), glycosylated hemoglobin (HbA1C), Cystin C (Cys-C), serum creatinine (Cr), and blood free fatty acid (FFA). Then, after taking orally 75g glucose Don't take 0.5 hours, 1 hours, 2 hours, 3 hours to take venous blood to measure blood sugar, insulin and C peptide. Compare the islet function of people with different cystatin levels. Data entry is Microsoft Office Excel2010, the area of C peptide release curve is calculated by Graph Pad Prism5. data using SPSS 16 software. Results: 1. patients with type 2 diabetic patients with different levels of serum cystatin C showed that with the level of cystatin C, age, course of disease, BMI, SBP, serum creatinine, coronary heart disease, the prevalence of multiple complications, Homa2%B, AUC2h and so on gradually increased; CCR, Homa2%S decreased gradually; HomaIR, AUCO.5h in cystatin was C normal The elevated levels of cystatin C and mild decrease in.2. Logistic regression analysis in the abnormality of cystatin C showed that cystatin C was an independent risk factor for diabetic nephropathy, diabetic retinopathy, and diabetic peripheral neuropathy,.3. correction of sex, age, BMI, course of disease, blood lipid, smoking history, drinking history, leukocyte With the history of coronary heart disease, serum creatinine level and other factors, the serum cystatin C level and Homa2-IR, the area under the 0.5 hour C peptide release curve (AUC 0.5h) were linear and positive correlation.3. Logistic regression analysis showed that in type 2 diabetic patients, the normal range of cystatin C and the abnormal elevated cystatin C were independent risk factors for insulin resistance. The increase in the risk of cystatin C and increased.4. Logistic regression analysis showed that cystatin C level was not an independent factor in islet function in type 2 diabetic patients. Conclusion: 1. with the increase of serum cystatin C level, the incidence of various diabetic complications is gradually increased; 2. serum cystatin C increase is type 2 diabetic patients. The independent risk factor for insulin resistance was.3. serum cystatin C level and no correlation with islet function in type 2 diabetic patients.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R587.1
【參考文獻(xiàn)】
相關(guān)期刊論文 前2條
1 劉燁;張琳;洪天配;;2011年糖尿病學(xué)領(lǐng)域的研究進(jìn)展和熱點(diǎn)回顧[J];中國(guó)醫(yī)學(xué)前沿雜志(電子版);2011年06期
2 閆萌萌;劉素筠;卓小群;;胱抑素C與2型糖尿病視網(wǎng)膜病變的相關(guān)性研究[J];中國(guó)藥物與臨床;2015年01期
，本文編號(hào)：2129317
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