不同糖代谢状态人群血清CTRP3和25(OH)D水平及其与胰岛素抵抗的关系

目的：测定不同糖代谢状态人群血清中C1q/肿瘤坏死因子相关蛋白3（CTRP3）和25羟维生素D25（OH）D]的水平，探讨其影响因素并分析其与胰岛素抵抗（IR）的关系。方法：选择初诊2型糖尿病（T2DM）患者44例（T2DM组）、糖耐量减低（IGT）患者42例（IGT组）和体检健康者54人（正常对照组），测定各组受试者血清中CTRP3、空腹静脉血糖（FPG）、糖化血红蛋白（HbA1c）、甘油三酯（TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、空腹胰岛素（FIns）和25（OH）D水平，计算体质量指数（BMI）、稳态模型IR指数（HOMA-IR）、稳态模型胰岛素分泌指数（HOMA-β），两因素之间相关性分析采用Pearson相关分析法，采用多元逐步回归分析法分析HOMA-IR和HOMA-β的影响因素。结果：与正常对照组比较，IGT组患者血清中HDL-C、25（OH）D水平和HOMA-β值明显降低（P<0.05），T2DM组患者血清中FPG、HbA1c、TG、TC、FIns水平和BMI、HOMA-IR值明显升高（P<0.05），而血清中CTRP3、HDL-C、25（OH）D水平和HOMA-β值明显降低（P<0.05）；与IGT组比较，T2DM组患者血清中FPG、HbA1c、TG、FIns水平和HOMA-IR值明显升高（P<0.05），血清中HDL-C水平和HOMA-β值明显降低（P<0.05）。不同糖代谢状态人群血清中CTRP3水平与HbA1c、FIns水平和HOMA-IR呈负相关关系（r=-0.391，P<0.05；r=-0.198，P<0.05；r=-0.481，P<0.05）；25（OH）D水平与TG、FPG和HOMA-IR呈负相关关系（r=-0.209，P<0.05；r=-0.406，P<0.05；r=-0.306，P<0.05），与HOMA-β呈正相关关系（r=0.329，P<0.05）。HbA1c和CTRP3为HOMA-IR的独立影响因素，25（OH）D、FPG和HbA1c为HOMA-β的独立影响因素。结论：血清CTRP3和25（OH）D水平与IR呈负相关关系，在糖尿病发生发展过程中起抑制作用。

Relationship between serum levels of CTRP3, 25(OH)D and insulin resistance in individuals with different glucose metabolism states

Objective:To detect the serum levels of CTRP3 and 25(OH) D in the individuals with different glucose metablism states,and to discuss the influence factors and analyze their relationships with insulin resistance(IR). Methods:Forty-four patients newly diagnosed T2DM(T2DM group),42 patients with impaired glucose regulation(IGT group),and 54 cases of normal controls(normal control group) were selected.The serum CTRP3, FPG,HbA1c,FIns,TG,TC,HDL-C, LDL-C,FIns of the subjects in various groups were determined, respectively;the BMI,HOMA-IR,HOMA-β were calculated.Pearson correlation analysis was used to analyze the correlation between two factors and multivariate stepwise regression analysis was used to analyze the influencing factors of HOMA-IR and HOMA-β. Results:Compared with normal control group, the serum levels of HDL-C, 25(OH)D and HOMA-β of the patients in IGT group were significantly decreased (P<0.05); the levels of serum FPG, HbA1c, TG, TC, FIns and BMI, HOMA-IR of the patients in T2DM group were significantly increased (P<0.05), while the levels of serum CTRP3, HDL-C, 25(OH)D and HOMA-β were significantly decreased(P<0.05). Compared with IGT group, the levels of serum FPG, HbA1c, TG, FIns, and HOMA-IR of the patients in T2DM group were significantly increased (P<0.05), and the level of serum HDL-C and HOMA-β were significantly decreased (P<0.05).The serum CTRP3 level was negatively correlated with the levels of HbA1c, FIns and HOMA-IR (r=-0.391, P<0.05; r=-0.198, P<0.05; r=-0.481, P<0.05); the 25(OH)D level was negatively correlated with the TG, FPG levels and HOMA-IR (r=-0.209, P<0.05; r=-0.406, P<0.05; r=-0.306, P<0.05), and positively correlated with HOMA-β (r=0.329, P<0.05) in the different glucose tolerance individuals. HbA1c and CTRP3 were the independent influencing factors of HOMA-IR, and 25(OH)D, FPG and HbA1c were the independent influencing factors of HOMA-β. Conclusion:The serum CTRP3 and 25(OH)D levels are negatively correlated with IR,and they have the inhibitory effects in the occurrence and development of diabetes mellitns.