【摘要】 目的 探讨血清和糖皮质激素诱导的蛋白激酶1(SGK1)、激肽释放酶7(KLK7)、脂联素(ADPN)水平与2型糖尿病(T2DM)合并代谢综合征(MS)患者糖脂代谢、胰岛素抵抗(IR)的相关性。方法 选取2021年8月—2024年8月沧州市中心医院内分泌糖尿病二科收治的T2DM患者229例为研究对象，根据患者是否并发MS分为MS组121例和非MS组108例。采用ELISA法检测血清SGK1、KLK7、ADPN水平; Pearson相关性分析血清SGK1、KLK7、ADPN水平和糖脂代谢、IR的相关性;多因素Logistic分析T2DM患者并发MS的影响因素; ROC曲线分析血清SGK1、KLK7、ADPN水平对T2DM患者合并MS的诊断价值。结果 与非MS组比较，MS组FPG、2 h PG、TG、TC、LDL-C、HOMA-IR、HOMA-β均升高，HDL-C降低(t/P=12.492/<0.001、10.676/<0.001、27.963/<0.001、21.813/<0.001、12.638/<0.001、23.899/<0.001、11.115/<0.001、17.965/<0.001); MS组血清SGK1、KLK7水平高于非MS组，ADPN水平低于非MS组(t/P=20.657/<0.001、14.955/<0.001、18.211/<0.001);血清SGK1、KLK7水平分别与FPG、2 h PG、TG、TC、LDL-C、HOMA-IR、HOMA-β呈正相关(r/P=0.373/<0.001、0.410/<0.001、0.364/<0.001、0.342/<0.001、0.436/<0.001、0.451/<0.001、0.416/<0.001,0.413/<0.001、0.364/<0.001、0.402/<0.001、0.382/<0.001、0.386/<0.001、0.408/<0.001、0.423/<0.001)，与HDL-C呈负相关(r/P=-0.402/<0.001,-0.363/<0.001); ADPN水平与FPG、2 h PG、TG、TC、LDL-C、HOMA-IR、HOMA-β呈负相关(r/P=-0.436/<0.001、-0.431/<0.001、-0.401/<0.001、-0.349/<0.001、-0.498/<0.001、-0.439/<0.001、-0.408/<0.001)，与HDL-C呈正相关(r/P=0.465/<0.001); BMI高、腰围大、臀围小、腰臀比大、SGK1高、KLK7高是T2DM患者合并MS的危险因素[OR(95%CI)=2.432(1.438～4.112)、3.015(1.862～4.883)、2.965(1.612～5.454)、3.164(1.622～6.173)、2.654(1.573～4.479)、3.012(1.641～5.530)],ADPN高是保护因素[OR(95%CI)=0.413(0.232～0.735)];血清SGK1、KLK7、ADPN水平单独及三者联合诊断T2DM患者合并MS的AUC分别为0.813、0.809、0.790、0.936，三者联合诊断的AUC高于单独指标(Z/P=2.726/0.007、2.732/0.006、2.741/0.004)。结论T2DM合并MS患者血清SGK1、KLK7水平升高，ADPN水平降低，三者与患者糖脂代谢、IR密切相关，联合检测对诊断T2DM合并MS有一定的临床价值。更多还原

【Abstract】 Objective To explore the correlation between serum and glucocorticoid-induced kinase 1(SGK1), kallikrein 7(KLK7), and adiponectin(ADPN) levels and glucose and lipid metabolisms and insulin resistance(IR) in patients with type 2 diabetes mellitus(T2 DM) complicated with metabolic syndrome(MS). Methods A total of 229 T2 DM patients admitted to the Department of Endocrinology and Diabetes II at Cangzhou Central Hospital from August 2021 to August 2024 were selected as the study subjects. According to whether the patients had MS, they were divided into an MS group and a nonMS group. Pearson correlation analysis was used to examine the relationships between serum SGK1, KLK7, ADPN and glucose-lipid metabolism and IR. Logistic regression analysis was performed to identify factors influencing MS in T2 DM patients.ROC curve analysis was conducted to evaluate the value of serum SGK1, KLK7, and ADPN in assessing MS in T2 DM patients. Results Compared with the non-MS group, the MS group showed significantly increased FBG, 2 hPBG, TG, TC,LDL-C, HOMA-IR, and HOMA-β, and significantly decreased HDL-C(t/P = 12.492/<0.001, 10.676/<0.001, 27.963/<0.001,21.813/<0.001, 17.965/<0.001, 23.899/<0.001, 11.115/<0.001, 12.638/<0.001). Serum SGK1 and KLK7 levels in the MS group were significantly higher than those in the non-MS group, while ADPN levels were significantly lower(t/P = 20.657/<0.001, 14.955/<0.001, 18.211/<0.001). Serum SGK1 and KLK7 were positively correlated with FBG, 2 hPBG, TG, TC, LDLC, HOMA-IR, and HOMA-β, and negatively correlated with HDL-C(r/P = 0.373/<0.001, 0.410/<0.001, 0.364/<0.001, 0.342/<0.001, 0.436/<0.001, 0.451/<0.001, 0.416/<0.001, 0.413/<0.001, 0.364/<0.001, 0.382/<0.001, 0.386/<0.001, 0.408/<0.001,0.423/<0.001,-0.402/<0.001,-0.363/<0.001). ADPN was negatively correlated with FBG, 2 hPBG, TG, TC, LDL-C, HOMAIR, and HOMA-β, and positively correlated with HDL-C(r/P =-0.436/<0.001,-0.431/<0.001,-0.401/<0.001,-0.349/<0.001,-0.498/<0.001,-0.439/<0.001,-0.408/<0.001, 0.465/<0.001). High BMI, large waist circumference, low hip circumference, high waist-to-hip ratio, high SGK1, and high KLK7 were independent risk factors for T2 DM patients with MS(all P <0.05), while high ADPN was an independent protective factor [OR(95%CI) = 2.432(1.438-4.112), 3.015(1.862-4.883),2.965(1.612-5.454), 3.164(1.622-6.173), 2.654(1.573-4.479), 3.012(1.641-5.530), 0.413(0.233-0.735)]. The AUCs of serum SGK1, KLK7, ADPN, and their combined assessment for diagnosing MS in T2 DM patients were 0.813, 0.809, 0.790,and 0.936, respectively, with the combined assessment showing the highest AUC(Z/P = 2.726/0.007, 2.732/0.006, 2.741/0.004).Conclusion There are abnormal changes in the levels of serum SGK1, KLK7, and ADPN in patients with T2 DM complicated with MS. All three markers are related to glucose and lipid metabolism and IR. Combined detection has certain clinical value for evaluating T2 DM complicated with MS.更多还原