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目的探讨初诊2型糖尿病(T2DM)患者血清视黄醇结合蛋白4(RBP4)水平与胰岛素抵抗(IR)的相关性。方法初诊T2DM患者(A组)60例随机均分为吡格列酮干预组(A1组)和二甲双胍干预组(A2组),另选取30例健康体检者作为对照(B组),测定干预前、后各组三酰甘油(TG)、空腹血糖(FBG)、空腹胰岛素(FIns)、糖化血红蛋白(HbA1c)和RBP4,计算体重指数(BMI)、胰岛素抵抗指数(HOMA-IR)和Homeβ细胞功能指数(HBCI)。结果A组血清RBP4、FBG、HbA1c、FIns和HOMA-IR高于B组,HBCI低于B组(P<0.05)。A1、A2组干预后FBG、HbA1c、FIns、RBP4、HOMA-IR、TG低于干预前,HBCI高于干预前(P<0.05)。A1组降低FBG、HbA1c、RBP4、HOMA-IR、TG优于A2组,而A2组降低BMI优于A1组(P<0.05)。A组患者血清RBP4水平与HOMA-IR、BMI、FIns和TG呈正相关(r=0.404、0.394、0.445和0.437,P<0.05)。结论初诊T2DM患者血清RBP4水平与IR正相关,减少RBP4的分泌可改善IR,增加胰岛素敏感性,吡格列酮干预效果优于二甲双胍。
Objective To investigate the relationship between serum retinol binding protein 4 (RBP4) and insulin resistance (IR) in newly diagnosed type 2 diabetes mellitus (T2DM). Methods A total of 60 newly diagnosed T2DM patients (group A) were randomly divided into two groups: pioglitazone intervention group (group A1) and metformin intervention group (group A2), and another 30 healthy subjects as control group (group B) TG, FBG, FIns, HbA1c and RBP4, body mass index (BMI), insulin resistance index (HOMA-IR) and Homeβ cell function index (HBCI ). Results Serum levels of RBP4, FBG, HbA1c, FIns and HOMA-IR in group A were higher than those in group B, while those in group B were lower than those in group B (P <0.05). The levels of FBG, HbA1c, FIns, RBP4, HOMA-IR and TG in A1 and A2 groups were lower than those before intervention and before HBCI (P <0.05). A1 reduced FBG, HbA1c, RBP4, HOMA-IR, TG better than A2, while A2 reduced BMI better than A1 (P <0.05). Serum RBP4 level in group A was positively correlated with HOMA-IR, BMI, FIns and TG (r = 0.404, 0.344, 0.445 and 0.437, P <0.05). Conclusions Serum RBP4 level in newly diagnosed T2DM patients is positively correlated with IR. Reducing the secretion of RBP4 can improve IR and increase insulin sensitivity, and the effect of pioglitazone intervention is better than that of metformin.