医药学论文：代谢综合征患者胰岛素抵抗与炎症反应标记物的相关性研究

【摘要】 目的 观察代谢综合征患者胰岛素抵抗(insulin resistance，IR)与血浆炎症反应标记物水平的关系，探讨炎症反应在代谢综合征患者胰岛素抵抗发生中的作用。方法 选择代谢综合征(metabolic syndrome,MS)患者31例，男19例，女12例，平均年龄(60.8±6.2)岁。正常健康对照20例，分别测定血浆高敏C反应蛋白(high-sensitivity C-reactive protein，Hs-CRP)、纤维蛋白原(fibrinogen，Fig)、空腹血糖(fasting blood glucose，FBG)、空腹血胰岛素(fasting insulin，FINS)和血脂等指标；计算胰岛素敏感指数(insulin sensitive index，ISI)。比较两组间空腹血浆炎症反应标记物水平的差异；并将空腹血浆高敏C反应蛋白、纤维蛋白原水平及MS的血脂参数分别与ISI作相关性分析。结果 代谢综合征组的ISI较正常健康对照组明显下降(P＜0.05)；血浆高敏C反应蛋白、纤维蛋白原水平等明显升高(P＜0.05)。多元线性回归显示:代谢综合征患者组高敏C反应蛋白、Fig、TG与ISI负相关(ｒ=-0.429，P＜0.01；ｒ=-0.312，P＜0.05；ｒ=-0.219，P＜0.05)。结论 （1）代谢综合征患者存在明显的胰岛素抵抗和血浆高敏C反应蛋白水平的异常。（2）慢性炎症状态可能是代谢综合征的特征之一。(3)炎症反应可能在代谢综合征患者胰岛素抵抗的发生中起了重要的作用。

 

【关键词】 代谢综合征；胰岛素抵抗；高敏C反应蛋白

 

Study on association of insulin resistance and inflammatory markers in patients with metabolic syndrome

 

【Abstract】 Objective To investigate the association of insulin resistance (IR) and inflammatory markers in patients with metabolic syndrome (MS)，and to explore the role of inflammatory markers in the development of IR in these patients. Methods 31 patients with MS were enrolled into study group，among of them，19 were male，and 12 were female，their average age was (60.8±6.2)y. The control group were made of 20 normal volunteers. The blood levels of high-sensitivity C-reactive protein (Hs-CRP)，fibrinogen (Fig)，fasting blood glucose (FBG)，fasting insulin，and plasma lipids were measured respectively in all the patients and normal subjects，and then，the insulin sensitive index was calculated. Differences of the levels of the fasting blood inflammatory markers between the two groups were compared，and the relative analyses between the Hs-CRP，Fig，blood lipid and ISI were made，respectively.Results Compared with the control group，the ISI of the MS group was significantly lower，but the levels of Hs-CRP and Fig were significantly higher. Multi-linear regression showed that，in MS group，the Hs-CRP，Fig，TG were inversely correlated with ISI，respectively(ｒ=-0.429，P＜0.01; ｒ=-0.312，P＜0.05; ｒ= -0.219，P＜0.05，respectively). Conclusion (1)There are IR and abnomal blood Hs-CRP level in patients with MS.(2)It can be hypothesized that the chronic inflammatory state may be a further feature of the metabolic syndrome.(3)The inflammatory reactions may play an important role in the development of IR in patients with MS.

 

【Key words】 metabolic syndrome; insulin resistance; high-sensitivity C-reactive protein

 

有研究表明，血浆高敏C反应蛋白不但是炎症反应标记物，它还能通过影响脂蛋白代谢、激活补体、促进巨噬细胞的吞噬功能、刺激单核细胞表面的组织因子表达等机制,参与动脉粥样硬化的发生、发展，是动脉粥样硬化发生的独立危险因素和预示因子之一［1,2］。代谢综合征(MS)是一组包括高血压、高脂血症、向心性肥胖、糖耐量减低、胰岛素抵抗、高胰岛素血症、高游离脂肪酸血症、高尿酸血症及微量白蛋白尿、纤溶和凝血功能异常、血栓前状态等致动脉粥样硬化危险因素症候群。胰岛素抵抗可能是代谢综合征的主要发病机制［3,4］，而胰岛素抵抗发生的原因目前尚不清楚。代谢综合征患者胰岛素抵抗与炎症反应标记物变化之间的关系研究报道较少。本研究应用灵敏度较高的免疫比浊法测定血浆高敏C反应蛋白水平，以探讨代谢综合征患者血浆高敏C反应蛋白水平与胰岛素抵抗之间的关系。