【摘要】 目的探讨2型糖尿病患者中合并糖尿病足者与胰岛素抵抗的关系,并分析其与血浆肿瘤坏死因子-α(TNF-α)及纤溶酶原激活剂抑制物-1(PAI-1)含量关系。方法研究80例2型糖尿病患者,其中35例糖尿病足患者作为病例组,45例无足部病变的糖尿病患者作为对照组。所有研究对象均检测空腹血糖、胰岛素、血脂。采用酶联免疫吸附双抗体夹心法(ELISA)原理定量测定血浆TNF-α和PAI-1含量。胰岛素抵抗指数(HOMA-IR)=FPG×FIns/22.5。结果糖尿病足患者的HOMA-IR显著高于无糖尿病足的患者(P<0.05)。采用相关分析发现,血浆PAI-1及TNF-α水平与HOMA-IR呈正相关(P<0.01)。多元回归分析显示血浆PAI-1、TNF-α水平、糖化血红蛋白(HbAlc)、体重指数(BM I)及低密度脂蛋白(LDL)是影响2型糖尿病足患者胰岛素抵抗的主要危险因素。结论糖尿病足患者存在着更严重的胰岛素抵抗,血浆PAI-1及TNF-α水平与HOMA-IR具有的正相关性,提示PAI-1及TNF-α等炎性因子参与胰岛素抵抗在糖尿病足的发病过程中起到一定的作用。更多还原

【Abstract】 Objective To study the relationship between insulin resistance and diabetic foot in patients with type 2 diabetes mellitus,and explore the relationships of them to plasma concentration of tumor necrosis factor-α（TNF-α） and plasminogen activator inhibitor-1（PAI-1）level.Methods Eighty patients with type 2 diabetes mellitus were selected randomly into the study,35 diabetic patients had foot complication and 45 without neuropathic ulceration were controls.The plasma lipid concentration,fasting blood glucose and insulin were measured.Plasma concentration of TNF-α and PAI-1 were determined by enzyme immunosorbent assays.Insulin resistance index（HOMA-IR）=FPG×FIns/22.5.Results HOMA-IR was significantly high（P<0.05） in patients with foot complication compared with patients without neuropathic ulceration.Plasma concentration of TNF-α and PAI-1 level were positively correlated with insulin resistance index（P<0.01）.The stepwise multiple regression analysis showed that PAI-1,TNFα,HbA_lc,BMI and LDL were the main risk factors leading to insulin resistance in type 2 diabetes mellitus.Conclusion Diabetic patients with foot complication have severer impairment of insulin resistance.The correlation between higher level of plasma concentration of TNF-α,PAI-1 and insulin resistance suggests that some inflammatory factors such as TNF-α and PAI-1 may play an important role in diabetic foot neuropathic ulceration.更多还原