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目的探讨初诊腹型肥胖2型糖尿病(T2DM)患者胰岛α、β细胞功能及其与视黄醇结合蛋白4(RBP-4)的关系,为进一步了解T2DM发病机制奠定基础。方法选取2012年2月至2014年6月在安徽医科大学第三附属医院内分泌科住院的初诊T2DM患者148例为研究对象。依腰围(WC)分为腹型肥胖组(AO)74例和非腹型肥胖组(NAO)74例。所有患者均检测糖化血红蛋白(Hb A1C)、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、极低密度脂蛋白胆固醇(VLDL-C)和血清RBP-4水平,行标准馒头餐试验,测定0、30、60、120、180 min各点血糖、C肽(CP)和胰高血糖素(Glc)水平。结果两组间年龄、Hb A1C、TC、LDL-C、HDL-C和VLDL-C差异均无统计学意义(P>0.05),AO组WC、腰臀比(WHR)、体质指数(BMI)、RBP-4、TG[分别为(95.11±6.49)cm、0.95±0.04、(26.82±2.28)kg/m2,(66.58±17.22)mg/L和(2.84±1.73)mmol/L]均明显高于NAO组[分别为(80.90±5.59)cm、0.90±0.05、(22.54±2.32)kg/m2、(60.70±14.57)mg/L和(2.16±1.67)mmol/L],差异均有统计学意义(P<0.05,P<0.01)。两组间各时间点血糖及血糖曲线下面积(AUCBG)差异均无统计学意义(P>0.05);AO组各时间点CP及C肽曲线下面积(AUCCP)和0、30、60 min Glc及胰高血糖素曲线下面积(AUCGlc)均高于NAO组,差异均有统计学意义(P<0.01,P<0.05)。且AO组AUCCP分别与BMI、WHR、Hb A1C呈明显的正相关(r值分别为0.423、0.187、0.362,P<0.05),AUCGlc分别与WC、TG呈明显的正相关(r值分别为0.317、0.263,P<0.05),RBP-4与0 min时间点Glc呈正相关(r=0.285 P<0.05)。NAO组AUCCP与Hb A1C、TG呈正相关(r值分别为0.174、0.158,P<0.05)。两组合并后,血清RBP-4与体重、BMI、WC、WHR、TG、TC呈正相关(r值分别为0.205、0.224、0.394、0.219、0.052和0.107,P<0.05,P<0.01),与经对数转换后0、30、60、120 min时间点CP和AUCCP呈正相关(r值分别为0.194、0.213、0.199、0.177和0.194,P<0.01),与HDL-C呈负相关(r=-0.011,P<0.05)。结论初诊腹型肥胖T2DM患者同时存在α、β细胞功能异常;RBP-4不仅影响初诊T2DM患者β细胞功能,亦可能参与腹型肥胖T2DM患者α细胞功能紊乱。
Objective To investigate the function of islet α and β cells in patients with newly diagnosed abdominal obesity type 2 diabetes mellitus (T2DM) and its relationship with retinol binding protein 4 (RBP-4), so as to lay a foundation for further understanding of the pathogenesis of T2DM. Methods From February 2012 to June 2014, 148 cases of newly diagnosed T2DM patients hospitalized in Department of Endocrinology, Third Affiliated Hospital of Anhui Medical University were selected as the research object. According to the waist circumference (WC), there were 74 abdominal obesity patients (AO) and 74 non-abdominal obesity patients (NAO). All patients were tested for Hb A1C, TG, TC, LDL-C, HDL-C, very low density lipoprotein (VLDL-C) and serum RBP-4 levels. The standard steamed bread meal test was used to measure the levels of blood glucose, C-peptide and glucagon at 0, 30, 60, 120 and 180 min. Results There were no significant differences in age, Hb A1C, TC, LDL-C, HDL-C and VLDL-C between the two groups (P> 0.05). WC, WHR, BMI, (95.11 ± 6.49) cm, 0.95 ± 0.04, (26.82 ± 2.28) kg / m2, (66.58 ± 17.22) mg / L and (2.84 ± 1.73) mmol / L] (80.90 ± 5.59) cm, 0.90 ± 0.05, (22.54 ± 2.32) kg / m2, (60.70 ± 14.57) mg / L and (2.16 ± 1.67) mmol / L, respectively) in NAO group.The differences were statistically significant Significance (P <0.05, P <0.01). There were no significant differences in the area under the curve of blood glucose and blood glucose (AUCBG) at each time point between the two groups (P> 0.05). The area under the curve of CP and C-peptide (AUCCP) and Glc And the area under the curve of glucagon (AUCGlc) were higher than NAO group, the differences were statistically significant (P <0.01, P <0.05). AUCCP in AO group was positively correlated with BMI, WHR and Hb A1C (r = 0.423,0.187,0.362, P <0.05), and AUCGlc was positively correlated with WC and TG (r = 0.317 , 0.263, P <0.05). There was a positive correlation between RBP-4 and Glc at 0 min (r = 0.285 P <0.05). There was a positive correlation between AUCCP and Hb A1C, TG in NAO group (r = 0.174,0.158, P <0.05). Serum RBP-4 was positively correlated with weight, BMI, WC, WHR, TG and TC (r = 0.205,0.224,0.394,0.219,0.052and0.107, P <0.05, P <0.01) There was a positive correlation between CP and AUCCP at 0, 30, 60, 120 min after logarithmic transformation (r = 0.194,0.213,0.199,0.177 and 0.194, respectively, P <0.01), but negatively correlated with HDL- -0.011, P <0.05). Conclusions There are concurrent dysfunction of α and β cells in T2DM patients with newly diagnosed abdominal obesity. RBP-4 not only affects β-cell function in newly diagnosed T2DM patients, but also may be involved in α-cell dysfunction in T2DM patients with abdominal obesity.