预混门冬胰岛素强化治疗对2型糖尿病患者血浆中成纤维细胞生长因子-21水平的影响

【】　目的　探讨预混门冬胰岛素对2型糖尿病（type2diabetesmellitus，T2DM）患者血浆成纤维细胞生长因子-21（fibroblastgrowthfactor-21，FGF-21）水平的影响。　方法　2008年2―12月采用酶联免疫吸附试验测定44例正常人及37例采用预混门冬胰岛素治疗前后的T2DM患者的血浆FGF-21水平，分析血浆FGF-21水平与体质量指数（bodymassindex，BMI）、体内脂肪百分比（FAT%）、腰臀比、血脂、血糖、糖化血红蛋白（hemoglobinA1c，HbA1c）、游离脂肪酸（freefattyacid，FFA）等的关系。　结果　治疗前T2DM组患者血浆FGF-21（1.79±0.04）μg/L水平明显高于正常对照组（1.35±0.21）μg/L，差异有统计学意义（P<0.01）。T2DM组经16周预混人胰岛素类似物（BIAsp50和BIAsp30）治疗后FFA、HbA1c、空腹血糖、餐后2h血糖均降低（P<0.01），空腹血浆FGF-21水平降低至（1.33±0.39）μg/L，与治疗前比较差异有统计学意义（P<0.01）。相关分析发现T2DM组患者血浆FGF-21水平与BMI呈正相关（r=0.53，P<0.01），BMI是影响T2DM患者血浆FGF-21水平的独立相关因素。　结论　预混人胰岛素类似物能有效改善T2DM患者代谢紊乱，同时能显著降低FGF-21水平。【Abstract】　Objective　Toinvestigatetheeffectsoftreatmentwithaspartinsulinonplasmafibroblastgrowthfactor-21(FGF-21)levelsinpatientswithtype2diabetesmellitus(T2DM).　Methods　FromFebruarytoDecember2008,plasmaFGF-21levelsweremeasuredbyenzyme-linkedimmunosorbentassayin37patientswithT2DMtreatedwithaspartinsulinand44normalcontrols.TherelationshipbetweenplasmaFGF-21levelsandbodymassindex(BMI),percentageofbodyfat(FAT%),waist-hipratio(WHR),bloodlipid,bloodglucose,hemoglobinA1c(HbA1c),andfreefattyacid(FFA)wasanalyzed.　Results　Beforetreatment,plasmaFGF-21levelwassignificantlyhigherinT2DMpatients(1.79±0.04)μg/Lthanthatinthenormalcontrols(1.35±0.21)μg/L(P<0.01).After16weeksoftreatmentwithpremixedhumaninsulinanalogues(BIAsp50andBIAsp30),FFA,HbA1c,fastingplasmaglucoseand2-hourpostprandialbloodglucosedecreasedsignificantly(P<0.01),andfastingplasmaFGF-21leveldecreasedto(1.33±0.39)μg/Lwhichwassignificantlydifferentfromthatbeforetreatment(P<0.01).CorrelationanalysisshowedthatplasmaFGF-21levelwaspositivelycorrelatedwithBMI(r=0.53,P<0.01),whichwasanindependentfactorininfluencingtheFGF-21levelinthepatients.　Conclusion　AspartinsulintreatmentcanremarkablyimproveglucosemetabolismandsignificantlydecreasethefastingplasmaFGF-21level.