骨膜蛋白与糖脂代谢紊乱及胰岛素抵抗的关系
Relationship of plasma periostin with glucolipid disorder and insulin resistance

摘要：目的 通过检测正常人群、肥胖及2型糖尿病(type 2 diabetes mellitus, T2DM)患者血浆中骨膜蛋白(periostin)水平，探讨骨膜蛋白与糖脂代谢紊乱、胰岛素抵抗及肥胖的关系。方法 83例新诊断的T2DM患者(T2DM组)和78例糖耐量(NGT组)正常个体以体质指数(body mass index, BMI)≥25kg/m？？2为分割点，将两组再分为正常体质量(NW)亚组和肥胖(OB)亚组。ELISA法检测骨膜蛋白及肿瘤坏死因子α(TNF-α)水平。分析骨膜蛋白与空腹血糖(FPG)、2h血糖(2hPG)、糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)、血脂、TNF-α以及BMI、腰臀比(WHR)和血压等指标的关系。通过稳态模型(HOMA)评估胰岛素抵抗(HOMA-IR)。结果 ①T2DM组血浆骨膜蛋白水平显著高于NGT组(P<0.01)，T2DM组及NGT组内肥胖亚组血浆骨膜蛋白水平显著高于正常体质量亚组(P<0.01)。②Pearson相关分析显示血浆骨膜蛋白水平与年龄、收缩压、身高、低密度脂蛋白胆固醇(LDL-C)无相关(P>0.05)，而与舒张压、腰围、臀围、体质量、BMI、WHR、总胆固醇(TC)、甘油三酯(TG)、FPG、2hPG、FINS、HbA1c、HOMA-IR及TNF-α呈正相关(P<0.01，P<0.05)，与高密度脂蛋白胆固醇(HDL-C)呈负相关(P<0.01)。③以骨膜蛋白为因变量行多元逐步回归分析，骨膜蛋白水平与TG、HOMA-IR、TNF-α独立相关(均P<0.01)。结论 新诊断的T2DM和肥胖患者血浆骨膜蛋白水平升高，骨膜蛋白与肥胖、糖脂代谢紊乱、炎症及胰岛素抵抗密切相关。
ABSTRACT: Objective To detect plasma periostin level in normal population, patients with obesity or type 2 diabetes mellitus (T2DM) so as to explore the relationship of periostin with glucolipid metabolism, insulin resistance and obesity. Methods We enrolled 83 patients with newly diagnosed T2DM (T2DM group) and 78 patients with normal glucose tolerance (NGT group) and divided each group into non-obese and obese subgroups. Obesity was defined as body mass index (BMI)≥25kg/m？？2 according to the World Health Organization―Western Pacific Region Diagnostic Criteria (2000). Body fat parameters were measured and BMI, waist-hip ratio (WHR) were evaluated; meanwhile, the levels of blood glucolipid parameters and fasting insulin were also determined. Insulin resistance index (IR) was assessed by homeostasis model assessment (HOMA). The concentrations of plasma periostin and tumor necrosis factory α (TNF-α) were detected by ELISA. Results Plasma periostin level was significantly higher in T2DM group than in NGT group (P<0.01). The level of plasma periostin in subjects with obesity was also higher than that in subjects with non-obesity in both T2DM and NGT groups (P<0.01).Correlation analysis showed that plasma periostin level was positively correlated with diastolic blood pressure,weight, waist circumference, WHR, BMI, glycosylated hemoglobin, fasting insulin, fasting plasma glucose, 2h postprandial plasma glucose, total cholesterol, triglycerides, HOMA-IR, and TNF-α(P<0.01, P<0.05); but negatively correlated with high-density lipoprotein-cholesterol (P<0.01). Multiple linear regression showed that HOMA-IR, triglycerides, and TNF-α were independent related factors in influencing the level of plasma periostin (P<0.01). Conclusion Plasma periostin level was increased in obesity and T2DM subjects