糖耐量正常的腹型肥胖男性TNF-α、IL-6、 25-（OH）D3 水平及与胰岛素抵抗的相关性

The level of TNF-α, IL-6, 25-(OH)D3 in abdominal obese men with normal glucose tolerance and its correlation with insulin resistance

摘要:

目的 探讨糖耐量正常的腹型肥胖男性肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）、 25- 羟维生素D3[25-（OH）D3] 水平及与胰岛素抵抗（IR）的相关性。方法 选取2017 年11 月—2018 年 2 月在秦皇岛市第一医院体检的101 例糖耐量正常男性为研究对象，其中腰围≥ 90 cm 为肥胖组（52 例），腰 围<90 cm 为对照组（49 例），分别测定TNF-α、IL-6、C 反应蛋白（CRP）、25-（OH）D3、总胆红素（TBIL）、 间接胆红素（IBIL）、直接胆红素（DBIL）、胆汁酸（BA）等。结果 肥胖组腰围、体重指数（BMI）、收缩压（SBP）、 舒张压（DBP）、甘油三酯（TG）、BA、CRP、空腹胰岛素（FINS）、TNF-α、IL-6、HOMA-IR 高于对照 组（P <0.05），高密度脂蛋白（HDL）、TBIL、DBIL、25-（OH）D3 低于对照组（P <0.05）。TNF-α 与BMI、 腰围、DBP、HOMA-IR 呈正相关（r =0.424、0.421、0.416 和0.456，P <0.05）， 与DBIL、25-（OH）D3 呈负相关（r =-0.474 和-0.483，P <0.05）。IL-6 与BMI、腰围、HOMA-IR 呈正相关（r =0.400、0.436 和 0.559，P <0.05），与DBIL、25-（OH）D3 呈负相关（r =-0.432 和-0.452，P <0.05）。多元线性回归分析显示， 25-（OH）D3 [b'=-0.183（95% CI ：-0.345，-0.021）] 是IR 的保护因素，IL-6[b'=0.329（95% CI ：0.175， 0.483）] 是IR 的危险因素。结论 糖耐量正常腹型肥胖男性存在血脂代谢紊乱、血压异常，IR、维生素D 水平下降及机体慢性炎症反应增强，且机体慢性炎症反应增强及维生素D 水平下降可能是IR 的重要危险 因素。

Abstract:

Objective To investigate the level of TNF-α, IL-6, 25-(OH)D3 and its relationship with insulin resistance in abdominal obese men with normal glucose tolerance. Methods This case-control study included 52 abdominal obese men (waist circumference ≥ 90 cm) and 49 non-abdominal obese men (waist circumference < 90 cm) with normal glucose tolerance. TNF-α, IL-6, CRP, total bilirubin (TBIL), indirect bilirubin (IBIL), direct bilirubin (DBIL), bile acid (BA) and 25-(OH)D3 were measured. Besides, the risk factors of insulin resistance were analyzed with multiple linear regression. Results Compared with the control group, the levels of waist circumference (WC), body mass index (BMI), diastolic blood pressure (DBP), systolic blood pressure (SBP), triglyceride (TG), fasting insulin (FINS), TNF-α, IL-6, CRP, BA, and HOMA-IR increased in abdominal obese group (P < 0.05), while TBIL, DBIL, high density lipoprotein (HDL), and 25-(OH)D3 decreased in abdominal obese group (P < 0.05). BMI (r =0.424), WC (r =0.421), DBP (r =0.416) and HOMA-IR (r =0.456) showed a positive correlation with TNF-α (P < 0.05). However, DBIL (r =-0.474) and 25-(OH)D3 (r =-0.483) were negatively correlated with TNF-α (P < 0.05). BMI (r =0.400), WC (r =0.436) and HOMA-IR (r =0.559) showed a positive correlation with IL-6 (P < 0.05), whereas DBIL (r =-0.432) and 25-(OH)D3 (r =-0.452) were negatively correlated with IL-6 (P < 0.05). The level of 25-(OH)D3 [b =-0.183, (95% CI: -0.345, -0.021)] was the protective factor of HOMA-IR, while IL-6 [b =0.329, (95% CI: 0.175, 0.483)] was the risk factor of HOMA-IR. Conclusions Abdominal obese men with normal glucose tolerance develop dyslipidemia, abnormal blood pressure, insulin resistance, decreased vitamin D and enhanced chronic inflammatory responses, in which enhanced chronic inflammatory responses and vitamin D may play an important role in insulin resistance.