2型糖尿病患者脂质比值、胰岛β细胞功能指数、超敏C反应蛋白与胰岛素抵抗的相关性研究

Correlation between lipid ratio, β cell function index, hypersensitive C-reactive protein and insulin resistance in type 2 diabetes mellitus

摘要:

目的 探讨2型糖尿病（T2DM）患者总胆固醇（TC）与高密度脂蛋白胆固醇（HDL-C）比值、甘油三酯（TG）与HDL-C比值、低密度脂蛋白胆固醇（LDL-C）与HDL-C比值、胰岛β细胞功能指数（HOMA-β）、超敏C反应蛋白（hs-CRP）与胰岛素抵抗的相关性。方法 选取2022年1月—2022年8月于吉林大学第二医院内分泌科住院的134例T2DM患者。根据稳态模型评估的胰岛素抵抗指数（HOMA-IR）四分位数间距将患者分为4组，A组（HOMA-IR < 3.6889），B组（3.6889 ≤ HMOA-IR < 5.5793），C组（5.5793 ≤ HOMA-IR< 8.6986），D组（HOMA-IR ≥ 8.6986）。比较4组患者的血生化指标、血细胞比值和脂质比值等；采用Spearman相关分析各指标与HOMA-IR的相关性；采用多元线性逐步回归模型分析T2DM患者胰岛素抵抗的影响因素。结果 4组患者的TG、TG/HDL-C、空腹血糖（FBG）、糖化血红蛋白（HbA1c）、空腹胰岛素（FINS）、HOMA-IR、HOMA-β、单核细胞计数比较，差异有统计学意义（P <0.05）。与A组相比，B组的FINS和HOMA-IR升高（P <0.05），C组的TG、TG/HDL-C、FINS、HOMA-IR、单核细胞计数升高（P <0.05），D组的FBG、FINS、HOMA-IR、HOMA-β升高（P <0.05）；与B组比较，C组的HOMA-IR升高（P <0.05），D组的FBG、HOMA-IR、FINS升高（P <0.05）；与C组相比，D组的FINS和HOMA-IR升高（P <0.05）。Spearman相关分析显示，HOMA-IR与TG（r_s =0.234，P =0.007）、TC/HDL-C（r_s =0.234，P =0.006）、TG/HDL-C（r_s =0.258，P =0.003）、FBG（r_s =0.321，P =0.000）、HbA1c（r_s =0.236，P =0.006）、FINS（r_s =0.844，P =0.000）、HOMA-β（r_s =0.265，P =0.002）、单核细胞计数（r_s =0.245，P =0.004）、LDL-C/HDL-C（r_s =0.172，P =0.046）、hs-CRP（r_s =0.170，P =0.049）呈正相关，与PNR（r_s =-0.196，P =0.023）呈负相关。多元线性逐步回归分析显示FBG、HbA1c、FINS、单核细胞计数是T2DM患者HOMA-IR的独立危险因素（P <0.05）。结论 T2DM患者的LDL-C/HDL-C、TC/HDL-C、TG/HDL-C、HOMA-β、hs-CRP与IR有相关性，FBG、HbA1c、FINS、单核细胞计数是T2DM患者胰岛素抵抗的独立危险因素。

Abstract:

Objective To explore the correlation of the ratio of total cholesterol (TC) to high-density lipoprotein cholesterol (HDL-C), triglyceride (TG) to HDL-C, low-density lipoprotein cholesterol (LDL-C) to HDL-C, homeostasis model assessment-β (HOMA-β) and hypersensitive C-reactive protein (hsCRP) with insulin resistance.Methods A total of 134 patients with T2DM who were hospitalized in the Department of Endocrinology of the Second Hospital of Jilin University from January 2022 to August 2022 were selected. According to the interquartile range of insulin resistance index (HOMA-IR) assessed by homeostasis model, the patients were divided into four groups, group A (HOMA-IR < 3.6889), group B (3.6889 ≤ HMOA-IR < 5.5793), group C (5.5793 ≤ HOMA-IR < 8.6986), group D HOMA-IR ≥ 8.6986). The blood biochemical indicators, blood cell ratio and lipid ratio were compared among the four groups of patients, and the correlation with insulin resistance was observed.Results TG, TG/HDL-C, FBG, HbA1c, FINS, HOMA-IR, HOMA-β, monocyte count (P < 0.05) among four groups A, B, C, and D There is a difference, and the difference is statistically significant. Compared with group A, the levels of FINS and HOMA-IR in group B increased (P < 0.05), and the levels of TG, TG/HDL-C, FINS, HOMA-IR, and monocyte count in group C increased (P < 0.05), the levels of FBG, FINS, HOMA-IR, HOMA-β in group D increased (P < 0.05); compared with group B, the level of HOMA-IR in group C increased (P < 0.05), D The levels of FBG, HOMA-IR, and FINS in the group increased (P < 0.05); compared with group C, the levels of FINS and HOMA-IR in group D increased (P < 0.05). Spearman correlation analysis showed that HOMA-IR was correlated with TG (r_s = 0.234, P =0.007), TC/HDL-C (r_s = 0.234, P = 0.006), TG/HDL-C (r_s = 0.258, P =0.003), FBG (r_s = 0.321, P = 0.000), HbA1c (r_s = 0.236, P = 0.006), FINS (r_s = 0.844, P = 0.000), HOMA-β (r_s = 0.265, P = 0.002), monocyte count (r_s = 0.245, P = 0.004), LDL-C/HDL-C (r_s = 0.172, P = 0.046), and high-sensitivity C-reactive protein (r_s = 0.170, P =0.049) were positively correlated with PNR (r_s = -0.196, P = 0.023) were negatively correlated. The results of multiple linear regression analysis showed that FBG, HbA1c, FINS, and monocyte count were independent risk factors for HOMA-IR in T2DM patients (P <0.05).Conclusion The increase of LDL-C/HDL-C, TC/HDL-C, TG/HDL-C, HOMA-β and hypersensitive C-reactive protein in patients with T2DM is correlated with insulin resistance. FBG, HbA1c, FINS, and monocyte count are independent risk factors for HOMA-IR in T2DM patients.