2型糖尿病患者炎性因子与糖脂代谢指标的相关性及其预测微血管病变的价值

张磊; 乔岗; 韩丽; 王娟

doi:10.7619/jcmp.20230092

2型糖尿病患者炎性因子与糖脂代谢指标的相关性及其预测微血管病变的价值

Correlation of inflammatory factors with glycolipid metabolism indicators in patients with type 2 diabetes and its value in predicting microangiopathy

摘要

摘要:
目的探讨2型糖尿病(T2DM)患者炎性因子水平与胰岛素抵抗、糖脂代谢指标的关系及其预测微血管病变的价值。
方法选取T2DM患者1 008例为研究对象, 其中发生微血管病变的405例患者设为微血管病变组，未发生微血管病变的603例患者设为非微血管病变组。比较2组患者的白细胞介素-6(IL-6)、白细胞介素-1β(IL-1β)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、胰岛素抵抗指数(HOMA-IR)、胰岛β细胞功能指数(HOMA-β)、空腹血糖(FBG)、24 h平均血糖(MBG)、24 h血糖波动(BGFR)、24 h血糖标准差(SDBG)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)水平。分析IL-6、IL-1β、CRP、TNF-α与HOMA-IR、HOMA-β、FBG、MBG、BGFR、SDBG、TC、TG、HDL、LDL水平的相关性。分析IL-6、IL-1β、CRP、TNF-α联合检测对微血管病变的预测效能。
结果微血管病变组IL-6、IL-1β、CRP、TNF-α、HOMA-IR、HOMA-β、FBG、HbA1c、MBG、BGFR、SDBG、TG、TC、LDL水平高于非微血管病变组, HDL低于非微血管病变组，差异均有统计学意义(P < 0.05)。相关性分析结果显示, IL-6、IL-1β、CRP、TNF-α与HOMA-IR、HOMA-β、FBG、MBG、BGFR、SDBG、TC、TG、LDL呈正相关(P < 0.001), 与HDL呈负相关(P < 0.001)。受试者工作特征(ROC)曲线分析显示, T2DM患者发生微血管病变的IL-6、IL-1β、CRP、TNF-α的阈值分别为34.42 pg/mL、1.53 pg/mL、6.84 mg/mL、44.11 pg/mL。
结论 T2DM患者炎性因子水平与糖脂代谢、胰岛素抵抗具有相关性，多种炎性因子联合检测对微血管病变具有显著的预测价值。

Abstract:
Objective To investigate the relationships of inflammatory factors levels with insulin resistance and glycolipid metabolism indicators in patients with type 2 diabetes mellitus (T2DM) and its value in predicting microangiopathy.
Methods A total of 1 008 patients with T2DM were selected as the research objects, of which 405 patients with microangiopathy were assigned to microangiopathy group, and 603 patients without microangiopathy were assigned to non-microangiopathy group. The levels of interleukin-6 (IL-6), interleukin-1β (IL-1β), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), homeostasis model assessment of insulin resistance (HOMA-IR), homeostasis model assessment of β cell function (HOMA-β), fasting blood glucose (FBG), 24-hour mean blood glucose (MBG), 24-hour blood glucose fluctuation (BGFR), 24-hour standard deviation of blood glucose (SDBG), total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL) and low-density lipoprotein (LDL) were compared between the two groups. The correlations of IL-6, IL-1β, CRP and TNF-α with HOMA-IR, HOMA-β, FBG, MBG, BGFR, SDBG, TC, TG, HDL and LDL levels were analyzed. The predictive efficacy of combined detection of IL-6, IL-1β, CRP and TNF-α for microangiopathy was analyzed.
Results The levels of IL-6, IL-1β, CRP, TNF-α, HOMA-IR, HOMA-β, FBG, HbA1c, MBG, BGFR, SDBG, TG, TC and LDL in the microangiopathy group were significantly higher than those in the non-microangiopathy group, while HDL was significantly lower than that in the non-microangiopathy group (P < 0.05). Correlation analysis showed that IL-6, IL-1β, CRP and TNF-α were positively significantly correlated with HOMA-IR, HOMA-β, FBG, MBG, BGFR, SDBG, TC, TG and LDL (P < 0.001), and were negatively significantly correlated with HDL (P < 0.001). The receiver operating characteristic (ROC) curve analysis showed that the thresholds of IL-6, IL-1β, CRP and TNF-α for the occurrence of microangiopathy in patients with T2DM were 34.42 pg/mL, 1.53 pg/mL, 6.84 mg/mL and 44.11 pg/mL, respectively.
Conclusion In patients with T2DM, level of inflammatory factors is correlated with glycolipid metabolism and insulin resistance, and combined detection of multiple inflammatory factors shows a significant predictive value for microangiopathy.

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