2型糖尿病患者胰岛素样生长因子1水平及相关影响因素

为了探讨2型糖尿病(T2D)患者外周血血清胰岛素样生长因子1(IGF-1)水平与糖脂代谢水平的关系,分析T2D患者血清IGF-1的相关影响因素。通过选取2010年5月～2012年1月就诊于内蒙古医科大学附属医院、内蒙古中医院内分泌科的179例T2D住院患者作为病例组(T2D组),另选取30例内蒙古医科大学体检中心正常健康体检者作为对照组(CK组)。采集研究对象空腹外周血,应用ELISA法检测血清IGF-1水平;检测T2D患者生化血脂指标和糖代谢指标水平,利用调查问卷收集研究对象的一般资料、行为习惯和体格检查,计算体质指数(BMI)、胰岛素抵抗指数(HOMA-IR)及胰岛素敏感性指数(HOMA-IS)。将T2D组患者IGF-1水平按照第25、75百分位数分为低IGF-1水平组(B组)、中IGF-1水平组(C组)和高IGF-1水平组(D组),CK组为对照组(A组)进行比较的方法,研究IGF-1水平与以上指标的相关性。结果表明:T2D组与CK组IGF-1水平差异显著(P 0. 01)。A组、B组、C组和D组比较中,年龄、性别、吸烟史、饮酒史、运动情况及BMI差异显著(P 0. 05);空腹血糖(FPG)、餐后2 h血糖(2PPBS)和糖化血红蛋白(Hb Alc)差异有统计学意义;三组载脂蛋白A(Apoal)均与对照组差异显著,D组的高密度脂蛋白胆固醇(HDL-C)与A组相比差异有统计学意义。相关性分析显示,血清IGF-1水平与运动情况(Spearman铁相关系数为0. 23,P=0. 001)存在关联。以IGF-1浓度为因变量的多因素Logistic回归分析中,血清IGF-1水平与胰岛素敏感性、年龄、BMI和Apoal、FPG、空腹胰岛素(FINS)及Hb Alc的交互作用正相关,与HDL-C负相关。可见胰岛素敏感性、年龄、BMI及Apoal、FPG、FINS与Hb Alc的交互作用可能为IGF-1水平的独立危险因素,HDL-C可能为独立保护因素。

Study on IGF-1 level and related factors in patients with type 2 diabetes

Abstract Object: To investigate the relationship between serum levels of insulin-like growth factor-1 (IGF-1) and glucose and lipid metabolism in patients with type 2 diabetes (T2D), and to analyze related factors of serum IGF-1 in patients with T2D. Methods: From May 2010 to January 2012, 179 cases of T2D hospitalized patients in the Department of Endocrinology, Inner Mongolia Medical University Hospital and Inner Mongolia Traditional Chinese Medicine Hospital were selected as the case group (T2D group), and another 30 cases of internal medicine medical center of Inner Mongolia Medical University were selected for normal health. The physical examination was used as a control group (CK group). The fasting peripheral blood of the study subjects were collected. The serum IGF-1 level was detected by ELISA. The biochemical lipid index and glucose metabolism index of T2D patients were detected. The general data, behavioral habits and physical examination of the subjects were collected by questionnaire. The body mass index (BMI), insulin resistance index (HOMA-IR) and insulin sensitivity index (HOMA-IS) were calculated. IGF-1 levels in the T2D group were divided into low IGF-1 level group (group B), middle IGF-1 level group (group C) and high IGF-1 level group (group D) according to the 25th and 75th percentile ,and was compared with the control group ,CK group(group A), and the correlation between IGF-1 and the above indicators was analyzed. Results: The levels of IGF-1 in the T2D group and the CK group were significantly different (P<0.01). Age, gender, smoking history, drinking history, exercise status, and BMI were significantly different in group A, group B, group C, and group D (P<0.05); The difference between CK group with others in fasting blood glucose (FPG), postprandial 2-hour blood glucose (2PPBS) and glycosylated hemoglobin (HbAlc) was significant.The apolipoprotein A was significantly different from the control group. The high density lipoprotein cholesterol (HDL-C) in group D was significantly different from that in group A. Correlation analysis showed that serum IGF-1 levels were associated with exercise (rs = 0.23, P = 0.001). In the multivariate logistic regression analysis with IGF-1 as the dependent variable, serum IGF-1 levels were positively correlated with insulin sensitivity, age, BMI and interaction of Apoal, FPG, FINS and HbAlc, and negatively correlated with HDL-C. Conclusions: Insulin sensitivity, age, BMI, and the interaction of Apoal, FPG, FINS, and HbAlc may be independent risk factors for IGF-1 levels, and HDL-C may be an independent protective factor.