【作者】 唐勇； 宋光耀； 张万兴； 张明明； 曲东明； 杨秀红；

【Author】 Tang Yong;Zhang Wan-xing;Song Guang-yao;Department of Endocrinology,Hebei General Hospital;

【机构】 河北省人民医院内分泌科、普外三科；

【摘要】 目的:胰岛素抵抗与肥胖和甘油三酯的蓄积相关,本研究通过观察胰岛素抵抗人群内脏脂肪组织和皮下脂肪组织中脂肪甘油三酯脂酶(ATGL)mRNA及蛋白的表达,探索脂肪动员过程中的相关酶在胰岛素抵抗发生发展中的作用。方法:选择本院择期行胆囊结石及胆管结石手术的住院病人,排除急性炎症、肿瘤、肝肾功能不全及其他影响机体代谢的内分泌疾病如甲状腺功能亢进、Cushing综合征、多囊卵巢综合征等。所有入选病例均记录年龄、身高和体重,测量体重指数和血压,过夜空腹10小时抽取静脉血测定血糖、血脂、血清胰岛素、C肽和血清游离脂肪酸。根据入选病例初入院时的空腹血糖及空腹胰岛素,计算胰岛素抵抗指数(HOMA-IR=空腹血糖×空腹胰岛素/22.5),所有入选病例HOMA-IR的中位数为2.96,以HOMA-IR指数分为胰岛素敏感组和胰岛素抵抗组。所有病例均签署知情同意书,并于术日手术过程中取腹部皮下脂肪和腹腔内脂肪,半定量RT-PCR法测定脂肪组织中ATGLmRNA的表达,Western blot法测定脂肪组织中ATGL蛋白的表达。结果:(1)两组在性别构成和年龄构成上无差异,胰岛素抵抗组病例的体重指数、甘油三酯、空腹胰岛素、及游离脂肪酸均高于胰岛素敏感组,差异有统计学意义(P<0.05),而两组间收缩压、舒张压、血糖、胆固醇、低密度脂蛋白和高密度脂蛋白没有差异。(2)与胰岛素敏感组相比,无论是在腹腔内脂肪组织还是皮下脂肪组织,胰岛素抵抗组中ATGLmRNA和蛋白表达均减低,差异有统计学意义(P<0.05)。(3)直线相关分析显示:空腹胰岛素、HOMA-IR与游离脂肪酸和ATGL的表达呈负相关(r=-0.235、r=-0.356和r=-0.214,P<0.05)。结论:ATGL是脂肪组织甘油三酯分解为甘油二酯的限速酶,与脂肪组织基础状态下甘油三酯的分解相关,胰岛素抵抗状态时内脏脂肪组织和皮下脂肪组织中脂肪甘油三酯脂酶的表达均减低,可能导致了机体脂肪的蓄积,进一步加重胰岛素抵抗。更多还原

【Abstract】 Objective:Inuslin resistance is associated with obesity and increased triglyceride storage in tissues.The purpose of this study is to examine the expression of adipose triglyceride lipase(ATGL) in subcutaneous fat and visceral fat of insulin-resistant people and explore the function of ATGL in the development of insulin resistance.Methods:All subjects were collected from inpatients who were going to have selective cholecystectomy and signed the protocol.Based on the HOMA-IR,all cases were divided into two groups:insulin sensitive group and insulin resistant group.Subcutaneous fat and visceral fat were taken on operation day.RT-PCR was used to examine the mRNA expression of ATGL and Western blot analysis was used to evaluate protein expression.Results:1.Independant of gender and age,BMI,triglyceride,fasting insulin and free fatty acids were higher in insulin resistant group than those in insulin sensitive group;there were no significant difference in SBP,DBP,glucose,cholesterol,low density lipoprotein and high density lipoprotein of these two groups.2.Compared with insulin sensitive group,ATGL expression was decreased in both subcutaneous fat and visceral fat in insulin resistant group.3.Fasting insulin levels,HOMA-IR and free fatty acids were negatively correlated with ATGL mRNA and protein expression.Conclusion:ATGL is the rate-limiting enzyme of triglyceride to diglyceride,which is related with fat mobilzation in basic state.ATGL expression is decreased in both subcutaneous fat and visceral fat in insulin resistant group,which may result in accumulation of fat in tissues and aggravate insulin resistance.更多还原