目的 通过检测1型糖尿病(T1DM)患儿及T1DM合并酮症酸中毒患儿血清内脂素(visfatin)水平,探讨血清visfatin与T1DM及酮症酸中毒患儿的糖脂代谢及胰岛β细胞功能的相关性。方法 选取2010年6月-2014年6月于广元市中心医院门诊就诊和住院的1型糖尿病患儿82例,正常对照组31例,1型糖尿病患儿分为初诊T1DM组(T1DM I组) 61例,T1DM合并酮症酸中毒组(T1DM Ⅱ组) 21 例。比较三组血清visfatin水平、空腹血糖(FPG)、空腹胰岛素(Fins)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、游离脂肪酸(FFA)及糖化血红蛋白(HbAlc),体质指数(BMI)及腰臀比(WHR)。并进行T1DM I组和T1DM Ⅱ组的血清visfatin与其他监测指标的单因素相关性分析,及血清visfatin与其相关因素的多元线性逐步回归分析。结果 1)儿童T1DM I组血清visfatin水平明显低于正常对照组(P<0.01),T1DM Ⅱ组血清visfatin水平较T1DM I组明显降低(P<0.01)。2)采用Pearson 相关分析,在T1DM I组和T1DM Ⅱ组中血清visfatin均与BMI、WHR、HDL-C、Fins、Homa-β呈正相关,均与TC、TG、LDL-C、FFA、FPG、HbAlc呈负相关。多元线性逐步回归分析显示,T1DM I组和 T1DM Ⅱ组的WHR、FFA、FPG、Homa-β进入回归方程,WHR、FFA、FPG、Homa-β是影响血清visfatin水平的独立危险因素。结论 1型糖尿病及合并酮症酸中毒患儿血清visfatin水平较正常组明显降低,可能与内脏脂肪含量减少,糖脂代谢紊乱及胰岛β细胞功能损害有关。
Abstract
Objective To observe serum visfatin level in children with type 1 diabetes mellitus (T1DM) and children with T1DM combined with ketoacidosis and investigate the correlation between serum visfatin level and glucolipid metabolism and islet β-cell function of these children. Methods From June 2010 to June 2014,82 children with T1DM who visited doctors in the Outpatient Department and hospitalized in Guangyuan Center Hospital,and 31 healthy controls were enrolled.Children with only newly diagnosed T1DM were assigned into T1DM I group (n=61),and children with T1DM combined with ketoacidosis were assigned into T1DM Ⅱ group (n=21).Comparisons were analyzed made in serum visfatin level,FPG,Fins,TC,TG,HDL-C,LDL-C,FFA,HbAlc,BMI and WHR among the three groups.Single-factor correlation analysis was conducted between serum visfatin level and other monitoring indexes of T1DM I group and T1DM Ⅱ group,and multivariate regression analysis of the correlation between serum visfatin level and other relevant factors was also conducted. Results 1)T1DMI group was lower than normal control group in serum visfatin level(P<0.01),and T1DM Ⅱ group was lower than T1DM I group in serum visfatin level (P<0.01).2)Pearson correlation analysis showed that the serum visfatin levels of T1DM I group and T1DM Ⅱ group were positively correlated with BMI,WHR,HDL-C,Fins,Homa-β,and were negatively correlated with TC,TG,LDL-C,FFA,FPG and HbAlc.Multivariate linear regression analysis showed that WHR,FFA,FPG and Homa-β of T1DM I group and T1DM Ⅱ group entered regression equation,which indicated that WHR,FFA,FPG and Homa-β were independent risk factors for serum visfatin level. Conclusion Children with T1DM and children with T1DM combined with ketoacidosis are lower than healthy controls in serum visfatin level,which may be related with the reduction of the fat content in viscera,glucose and lipid metabolism disorder and dysfunction of islet β-cell.
关键词
1型糖尿病 /
糖尿病酮症酸中毒 /
糖脂代谢 /
胰岛β细胞功能
Key words
type 1 diabetes mellitus /
diabetic ketoacidosis /
glucolipid metabolism /
islet β-cell function
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参考文献
[1] Yan S,zhang B.The espanding hurden of cantionnabolie risk in hina:the China hralth and nutrition survery[J].Ohesicy Reviews,2012,13(9):810-821.
[2] Maahs DM,West NA,Lawrence JM,et al.Epidemiology of type 1 diabetes[J].Endocrinol Metab Clin North Am,2010,39(3):481-497.
[3] 季荔,杨涛.治愈1型糖尿病离我们有多远?[J].糖尿病天地:临床,2015,9(1):52-56.
[4] Brownj EP,Onyango DJ,Ramanjaneya M,et al.Visfatin regulates insulin secretion,insulin receptor signalling and mRNA expression of diabetes-related genes in mouse pancreatic p-cells[J].J Mol Endocrinol,2010,44(3):171-178.
[5] Revollo JR,Krner A,Mills KF,et al.Nampt/PBEF/visfatin regulates insulin secretion in β cells as a systemic NAD biosynthetic enzyme[J].Cell Metab,2007,6(5):363-375.
[6] 程群,彭永德,董维平,等.Visfatin通过线粒体途径抑制胰岛β细胞凋亡[J].上海交通大学学报:医学版,2009,29(8):922-925.
[7] 胡亚美,江载芳.诸福棠实用儿科学[M].7版.北京:人民卫生出版社,2002:2042-2043.
[8] 巩纯秀,杨秋兰.《中华医学会儿科学分会内分泌遗传代谢学组儿童糖尿病酮症酸中毒诊疗指南》(2009年版)解读[J].中国实用儿科杂志,2010,25(11):850-853.
[9] Fukuhara A,Matsuda M,Nishizawa M,et al.Visfatin:a protein secreted by visceral fat that mimics the effects of insulin[J].Science,2005,307(578):426-430.
[10] Toruner F,Altinova AE,Bukan N,et al.Plasma visfatin concentrations in subjects with type 1 diabetes mellitus[J].Horm Res,2009,72(1):33-37.
[11] Alexiadou K,Kokkinos A,Liatis SA,et al.Differences in plasma apelin and visfatin levels between patients with type 1 diabetes mellitus and healthy subjects and response after acute hyperglycemia and insulin administration[J].Hormones-International Journal of Endocrinology and Metabolism,2012,11(4):444-450.
[12] Bermejo AL,Julia BC,Balsells MF,et al.Serum visfatin increases with progressive beta-cell deterioration[J].Diabetes,2006,55(10):2871-2875.
[13] Haider DG,Pleiner J,Francesconi M,et al.Exercise training lowers plasma visfatin concentrations in patients with type 1 diabetes[J].J Clin Endocrinol Metab,2006,91(11):4702-4704.
[14] Song HK,Lee MH,Kim BK,et al.Visfatin:a new player[J].in mesangial cell physiology and diabetic nephropathy[J].Am J Physiol Renal Physiol,2008,295(5):F1485.
[15] 蒲云飞,何洪波,赵志钢,等.腹型肥胖内脏脂肪定量检测的评估及其临床意义[J].中华医学杂志,2008,88(34):2391-2394.
[16] Kitabchi AE,Umpierrez GE,Murphy MB,et al.American diabetes association.hypergly-cemic crises in diabetes[J].Diabetes Care,2004,27(Suppl 1):94-102.
[17] Mcevilly A,Kirk J.Twenty years of a multidisciplinary paediatric diabetes home care unit[J].Arch Dis Child,2005,90(4):342-345.
[18] 王秀敏,梁黎,董关萍,等.浙江省1999~2004年新诊断儿童1型糖尿病流行病学特征及血脂水平[J].实用儿科临床杂志,2006,21(8):471-472,482.
[19] Li J,Meng F,Song C,et al.Characterization of chicken visfatin gene:cDNA cloning,tissue distribution,and promoter analysis[J].Poult Sci,2012,91(11):2885-2894.
[20] 樊立娜,刘素筠.内脂素--糖尿病治疗的新靶点[J].医学研究杂志,2009,38(1):7-9,19.
基金
2015年广元市科技局科技计划立项项目(15KJZCZC003)
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