组织缺氧对2 型糖尿病患者胰岛素抵抗的影响

Effect of hypoxia on insulin resistance in patients with type 2 diabetes mellitus

摘要:

目的 探讨组织缺氧对2 型糖尿病（T2DM）患者胰岛素抵抗（IR）的影响。方法 选取2015 年1 月- 2016 年10 月该院门诊首次确诊的182 例T2DM 患者作为研究对象。检测所有患者空腹血糖（FPG）、空腹胰 岛素（Fins）、血红蛋白（Hb）、2，3- 二磷酸甘油酸（2，3-DPG）、缺氧诱导因子1α（HIF-1α）及乳酸等水平， 据此计算其胰岛素抵抗指数（HOMA-IR）与胰岛素敏感指数（HOMA-IS）；比较代谢综合征（MS）组（49 例） 和非MS 组（133 例）IR、组织缺氧相关指标，并根据患者Hb 水平的三分位数分成3 组；比较3 组IR、组织 缺氧相关指标。采用Pearson 相关系数分析各指标相关性。结果 MS 组FPG、Fins、HOMA-IR、Hb、HIF-1α 及血乳酸水平高于非MS 组，HOMA-IS 低于非MS 组（P <0.05）。随着Hb 水平提高，Fins、HOMA-IR、 HIF-1α、2，3-DPG 及血乳酸水平逐渐升高（P <0.05），而HOMA-IS 逐渐降低（P <0.05）。HOMA-IR 与 Hb、HIF-1α、2，3-DPG 及血乳酸水平均呈正相关（r =0.197、0.303、0.136 和0.153，P =0.017、0.000、0.067 和0.039），HOMA-IS 与Hb、HIF-1α、2，3-DPG 及血乳酸水平均呈负相关（r =-0.197、-0.303、-0.136 和 -0.153，P =0.017、0.000、0.067 和0.039）。结论 T2DM 患者存在慢性组织缺氧和IR 现象，两者有密切关系； 慢性组织缺氧可能诱发机体代谢紊乱，加速IR。

Abstract:

Objective To study the effect of hypoxia on insulin resistance (IR) in patients with type 2 diabetes mellitus (T2DM). Methods A total of 182 patients with T2DM first diagnosed in our hospital from January 2015 to March 2016 were enrolled to the study. Fasting plsama glucose (FPG), fasting insulin (Fins), hemoglobin (Hb), 2, 3-diphosphoglyceric acid (2, 3-DPG), hypoxia inducible factor-1α (HIF-1α) and lactic acid level were detected, then insulin resistance index (HOMA-IR) and insulin sensitivity index (HOMA-IS) were calculated. Hypoxia and IR indicators were compared between metabolic syndrome (MS) group (n = 49) and non-MS group (n = 133). All cases were divided into three groups according to the tri-sectional quantiles of Hb level, then hypoxia and IR indicators were compared among them. Pearson correlation coefficient was used to analyze the correlation of all indexes. Results The levels of FPG, FINS, HOMA-IR, Hb, HIF-1α and blood lactic acid in the MS group were significantly higher than those in the non-MS group, HOMA-IS was significantly lower than that in the non-MS group (P < 0.05). With the increase of Hb level, the levels of Fins, HOMA-IR, HIF-1α, 2, 3-DPG and lactic acid gradually increased (P < 0.05), while HOMA-IS gradually decreased (P < 0.05). HOMA-IR was positive correlated with Hb, HIF-1α,2, 3-DPG and blood lactic acid level (r = 0.197, 0.303, 0.136 and 0.153, P = 0.017, 0.000, 0.067 and 0.039), and HOMA-IS was negatively correlated with Hb, HIF-1α, 2, 3-DPG and blood lactic acid level (r = -0.197, -0.303, -0.136 and -0.153, P = 0.017, 0.000, 0.067 and 0.039). Conclusions Chronic hypoxia and IR exist in T2DM, and there is a close relationship between them. Chronic hypoxia may induce metabolic disturbance and accelerate IR.