【作者】 邓敏；

【导师】 邓华聪；

【作者基本信息】 重庆医科大学 ， 内科学， 2014， 硕士

【摘要】 目的：测定中国重庆地区正常人群、肥胖及2型糖尿病（T2DM）患者血浆补体C1q/肿瘤坏死因子相关蛋白-3（CTRP3）水平，探讨CTRP3与胰岛素抵抗等相关因素的关系，从而揭示CTRP3在肥胖、2型糖尿病进展中的作用机制，为CTRP3临床应用提供理论基础。方法：研究对象共174例，均行葡萄糖耐量试验，并按1999年WHO糖尿病诊断标准将其分为正常糖耐量组（NGT）88人和T2DM组86人，以BMI≥25kg/m2为分割点，进一步将该两组人群分为正常体重（NW）亚组和肥胖（OB）亚组。观察CTRP3水平与空腹血糖（FPG）2h血糖（2hPG），糖化血红蛋白（HbA1c），空腹胰岛素（FINS），血脂，白介素（IL）-6以及体质指数（BMI），腰臀比（WHR），血压等指标的关系。稳态模型评估胰岛素抵抗指数（HOMA-IR），HOMA-IR=Fins×FPG/22.5。血浆CTRP3及IL-6水平用ELISA法检测。结果：（1）T2DM组血浆CTRP3水平显著低于NGT组（[369.59±117.56）vs（445.42±124.03）ng/mL，P<0.01]，NGT组和T2DM组组内比较，OB亚组均低于NW亚组[（393.77±121.34）vs（494.77±106.14）ng/mL和（313.78±71.60）vs（430.83±127.98）ng/mL，P均<0.01]；（2）单因素相关分析显示血浆CTRP3水平与性别、年龄、血压和TC、LDL-C无相关（P>0.05），而与BMI、WC、WHR、FPG、2hPG、HbA1c、TG、FINS（P<0.01）负相关，与HDL-C正相关（P<0.05），与HOMA-IR及IL-6也呈负相关（P<0.01）。控制BMI、WC、WHR指标后，偏相关分析CTRP3仍与HOMA-IR、IL-6负相关；（3）以CTRP3为因变量进行多元线性逐步回归分析发现血浆CTRP3水平与HbA1c、TG、HOMA-IR独立相关（P<0.05）。结论：T2DM和肥胖患者血浆CTRP3水平较正常人明显降低；且与肥胖、糖脂代谢紊乱、炎症及胰岛素抵抗密切相关；HbA1c、TG、IR为血浆CTRP3的独立影响因素，低CTRP3水平可以预测肥胖及T2DM患者胰岛素抵抗。更多还原

【Abstract】 Objective：To detect C1q/TNF-related protein (CTRP)-3levels in healthy,obesityand type2diabetes mellitus (T2DM) subjects in Chongqing district and toinvestigate the association of plasma CTRP3levels with insulin resistanceindex and other related factors. Explor the possible mechanism of CTRP3effect in type2diabetes and obesity.Methods：The test included174subjects, Eighty-eight normal glucose tolerancepeople and eighty-six new diagnosed T2DM patients(the diagnosis criteriamade by WHO in1999). Normal weight (NW) and obese (OB) subgroupswere divided in each group when body mass index (BMI)≥25kg/m2. Everysubject was taken OGTT test. Analysed the relationships between plasmaCTRP3levels and fasting plasma glucose (FPG),2h plasma glucose(2hPG), HbA1C, fasting insulin (FINS), lipids and interleukin (IL)-6. BMI,waist-to-hip (WHR) and blood pressure were also evaluated. IR index was assessed by Homeostasis model assessment (HOMA).HOMA-IR=Fins×FPG/22.5. Plasma CTRP3and IL-6were detected byELISA.Results:(1) The levels of plasma CTRP3in T2DM group were significantlylower compared to NGT group[(369.59±117.56)vs(445.42±124.03)ng/mL，P<0.01], and plasma CTRP3concentration in OB subjects were alsosignificantly lower than those in NGT-NW and T2DM-NW subjects[(393.77±121.34)vs(494.77±106.14)ng/mLand(313.78±71.60)vs(430.83±127.98)ng/mL, P<0.01].(2) The single factor correlation analysis showedplasma CTRP3levels were not related to gender, age, blood pressure, TCand LDL-C (P>0.05), It was negatively related to BMI, WC, WHR, FPG,2hPG, HbA1c, TG, FINS (P<0.01), while positively related toHDL-C(P<0.05). Plasma CTRP3levels were still significantly negativelyrelated to HOMA-IR and IL-6even after BMI, WC, WHR were adjusted.(3) Multiple linear regression showed that HbA1c, TG and HOMA-IR wereindependently associated with plasma CTRP3levels (P <0.05).Conclusions：Plasma CTRP3levels were decreased in both obese and T2DMpatients compared to normal subjects, and it was correlated with obesity,glycolipid metabolism, inflammation and insulin resistance. HbA1c, TG andIR were independent factors affecting plasma CTRP3. Low CTRP3level could predict insulin resistance in patients with obese and T2DM.更多还原