【摘要】：背景與目的:2型糖尿病(T2DM)是一種慢性的血糖代謝紊亂為主、嚴重影響著人類健康的疾病,表現(xiàn)為從以胰島素抵抗為主伴隨胰島素進行性分泌不足到以胰島素進行性分泌不足為主伴隨不同程度的胰島素抵抗,近30年在中國的患病率迅速上升。大血管并發(fā)癥更是其致殘和致死的主要原因。胰島素抵抗(IR)是指各種原因?qū)е碌囊葝u素促進葡萄糖攝取和利用效率降低,繼而機體代償性分泌過多的胰島素所產(chǎn)生的高胰島素血癥。一般認為胰島素抵抗是引起血糖、血脂、尿酸、血壓異常的基礎(chǔ),是代謝綜合征發(fā)病的重要環(huán)節(jié)。血漿纖維蛋白原是機體凝血系統(tǒng)的中心蛋白,是血液循環(huán)中含量最高的凝血因子,在維持體內(nèi)纖溶系統(tǒng)和凝血系統(tǒng)的動態(tài)平衡中起著至關(guān)重要的作用,直接參與了動脈粥樣硬化的發(fā)生發(fā)展。有研究結(jié)果顯示在肥胖、多囊卵巢綜合癥(PCOS)、妊娠期糖尿病、老年2型DM患者中胰島素抵抗與FIB可能相關(guān)。本文旨在探討2型DM患者的血漿纖維蛋白原與胰島素抵抗的相關(guān)性。方法:在排除非2型糖尿病患者以及影響FIB水平的其他因素后,納入研究者所在醫(yī)院內(nèi)分泌科2015年7月至2016年7月期間住院2型糖尿病患者1006例。記錄入選者年齡、病程、性別等一般資料,入院后24h內(nèi)抽取空腹靜脈血送本院檢驗科,進行空腹血糖(FPG)、空腹胰島素(Fins)、空腹C肽(C-P)、糖化血紅蛋白(Hb A1c)、甘油三酯(TG)、血漿膽固醇(Chol)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)、尿酸(UA)、血漿纖維蛋白原(FIB)等相關(guān)生化指標測試,并計算HOMA-IR、BMI指數(shù)。按所有患者的FIB水平,采用四分位法分為四組。采用SPSS20.0(Ver20.0,IBM,USA)軟件進行數(shù)據(jù)分析。結(jié)果:本研究組2型糖尿病病人男性占60.3%,年齡分布于14-90歲,平均年齡55.7±12.7歲,病程分布于0-37年,平均病程7.7±7.0年,BMI分布于14.5-40.0 kg/m2,平均BMI25.3±3.3 kg/m2,28.9%未接受治療,39.7%接受單純口服降糖藥治療,14.1%接受單獨胰島素,17.3%接受胰島素+口服降糖藥治療。單因素方差分析顯示FIB四組的年齡、病程、C-P、Hb A1c、LDL-C、Chol隨FIB的升高呈增高趨勢;女性FIB水平比男性FIB水平高;組間總體差異有統(tǒng)計學意義(P0.05)。以FIB為因變量,以年齡、病程、性別、HOMA-IR、C-P、Hb A1c、BMI、TG、Chol、HDL-C、LDL-C、UA為自變量,進行線性逐步回歸分析,結(jié)果顯示:年齡、病程、性別、C-P、Hb A1c、LDL-C、UA進入回歸方程,回歸系數(shù)分別為:0.011、0.008、-0.197、0.301、0.035、0.109、0.001(P0.05)結(jié)論:2型糖尿病患者空腹C肽水平及其所反應(yīng)的胰島素抵抗程度可能是血漿纖維蛋白原水平升高的危險因素。
[Abstract]:Background & objective: type 2 diabetes mellitus (T2DM) is a chronic disorder of blood glucose metabolism, which seriously affects human health. In recent 30 years, the prevalence rate of insulin resistance increased rapidly in China, from insulin resistance mainly accompanied by progressive insulin secretion deficiency to insulin progressive secretion insufficiency with different degrees of insulin resistance. Macrovascular complications are the main cause of disability and death. Insulin resistance (IR) refers to the hyperinsulinemia caused by the decrease of glucose uptake and utilization efficiency and the compensatory secretion of insulin. It is generally believed that insulin resistance is the basis of abnormal blood glucose, blood lipids, uric acid and blood pressure, and is an important link in the pathogenesis of metabolic syndrome. Plasma fibrinogen is the central protein of the body's coagulation system and the highest concentration of coagulation factor in the blood circulation. It plays an important role in maintaining the dynamic balance between the fibrinolytic system and the coagulation system in the body. Directly involved in the occurrence and development of atherosclerosis. Studies have shown that insulin resistance may be associated with FIB in obese, polycystic ovary syndrome (PCOS),) gestational diabetes mellitus and elderly type 2 DM patients. The aim of this study was to investigate the relationship between plasma fibrinogen and insulin resistance in patients with type 2 DM. Methods: after excluding non-type 2 diabetic patients and other factors affecting the level of FIB, 1006 patients with type 2 diabetes mellitus were admitted from July 2015 to July 2016 in the Endocrinology Department of our hospital. The age, course and sex of the selected patients were recorded, and fasting venous blood samples were collected within 24 hours after admission to our laboratory for fasting blood glucose (FPG), fasting insulin (Fins), fasting C-peptide (C-P), fasting plasma glucose (FPG), fasting insulin (Fins), fasting C-peptide (C-P). Glycosylated hemoglobin (Hb A1c), triglyceride (TG), plasma cholesterol, (Chol), high density lipoprotein (HDL-C), low density lipoprotein (LDL-C), uric acid (UA), Plasma fibrinogen (FIB) and other related biochemical indexes were measured and HOMA-IR,BMI index was calculated. According to the FIB level of all patients, the quartile method was used to divide into four groups. SPSS20.0 (Ver20.0,IBM,USA) software is used for data analysis. Results: in this study group, 60.3 male patients with type 2 diabetes mellitus were aged 14-90 years with an average age of 55.7 鹵12.7 years. The course of disease was distributed between 0-37 years and the mean course of disease was 7.7 鹵7.0 years. BMI was distributed in 14.5-40.0 kg/m2, the average BMI25.3 鹵3.3 kg/m2,28.9% was not treated, 39.7% received oral hypoglycemic drugs alone, and 14.1% received insulin alone. 17.3% were treated with insulin oral hypoglycemic drugs. Univariate ANOVA analysis showed that the age, course of disease, the level of FIB in women was higher than that in men, and the overall difference between groups was statistically significant (P0.05). Taking FIB as dependent variable, age, course of disease, sex, HOMA-IR,C-P,Hb A _ 1C ~ (+) T _ (TMI) Choll (HDL-C) LDL-CU UA as independent variables, linear stepwise regression analysis was carried out. The results showed that age, course of disease, sex, C-P, and so on. The regression coefficient of Hb A1cU LDL-CU UA was 0.0110.008, and the regression coefficient was 0.0110.0008, respectively. Conclusion: the fasting C-peptide level and the degree of insulin resistance in type 2 diabetes mellitus patients may be the risk factors for the increase of plasma fibrinogen level.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R587.1

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