2型糖尿病患者空腹、餐后血清TNF-α、IL-6水平的研究

目的 探讨2型糖尿病(T2DM)患者空腹、餐后血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)水平的变化及其与胰岛素抵抗的相关性.方法 T2DM患者35例,对照组非糖尿病患者30例,分别测定空腹血糖(FPG)、胰岛素(IRI)、TNF-α、IL-6、总胆固醇(TC)及甘油三酯(TG)水平;T2DM组加测餐后血糖、胰岛素、TNF-α、IL-6水平.结果 T2DM组的胰岛素抵抗指数(HOMA-IR)、TNF-α、IL-6明显高于对照组(分别P＜0.01或＜0.05),T2DM组餐后的TNF-α、IL-6与空腹组比较无明显差异(P＞0.05).T2DM组TNF-α与FIG、IRI、HOMA-IR、TG成明显正相关(分别P＜0.01或＜0.05).IL-6与各项指标无明显相关性(P＞0.05).结论 T2DM患者的TNF-α、IL-6明显高于非糖尿病患者.TNF-α参与胰岛素抵抗的发生.进食引起的血糖、胰岛素水平波动不影响TNF-α、IL-6水平.

Abstract：

Objective To determine the fasting and postprandial serum level of TNF-α,IL-6 in type 2 diabetes mellitus(T2DM) and to investigate their correlation with insulin resistance.Methods Thirty-five patients of T2DM and thirty nondiabetic persons were included in the study.Basting plasma glucose(FPG) ,fasting insulin(Fins) ,TNF-α,IL-6,total cholesterol(TC) ,triglyceride(TG) were measured in both groups.Postprandial blood glucose,insulin,TNF-α,IL-6 were measured in the T2DM group.Results The levels of HOMA-IR,seYllm TNF-α and IL-6 in T2DM group were significantly higher than those in the control group(P<0.01 or<0.05).The level of postprandial TNF-α,IL-6 tended to increase,but the change was not significant(P>0.05).Pearson correlation analysis showed that TNF-α was positively correlated to FBG,HOMA-IR and TG in T2DM group(P<0.01).There was also a positive correlation between TNF-α and FINS in T2DM group(P<0.05).There was no correlation between IL-6 and other parameters(P>0.05).Conclusion The serum levels of TNF-α and IL-6 of T2DM patients were significantly higher than those in the nondiabetic persons.TNF-α was involved in insulin resistance.Postprandial brief elevation of serum levels of blood glucose and insulin did not have effect on those of TNF-α and IL-6.     

实施健康管理，提高全科医学教学与管理水平

健康管理学是以全科医学为基础,对个体或群体的健康危险因素进行全面分析评估,作出健康评价和疾病预测,并对全过程进行干预的一种服务,具有标准化、量化、个体化、系统化的特点。通过回顾健康管理服务的步骤、流程以及发达国家健康管理服务的主要模式,本教研室将健康管理服务的理念渗透人全科医生的培养计划。在临床实习过程中,结合具体病种,学习相关医学评估量表,以及慢性病临床诊治指南,通过案例教学法、开放式教学模式,提高学生的综合性医学逻辑思维、推理判断能力,培养他们的自主学习能力。本教研室突出科学地实施健康管理的教学设计,有助于提高全科医生的管理与教学水平。