血清胱抑素C、铁蛋白、胰岛素抵抗指数表达水平在2型糖尿病合并肥胖患者中的诊断价值

Diagnostic values of serum cystatin C, ferritin and insulin resistance index in patients with type 2 diabetes mellitus and obesity

摘要:

目的 探讨血清胱抑素C、铁蛋白（SF）、胰岛素抵抗指数（HOMA-IR）在2型糖尿病（T2DM）合并肥胖患者中的诊断价值。方法 选取2022年1月—2024年5月安庆市立医院内分泌科住院的107例T2DM及肥胖患者。根据体质量指数（BMI）及是否诊断为糖尿病分为单纯肥胖组、单纯T2DM组、T2DM合并肥胖组，分别有25、33和49例。并选取同期该院40例健康体检者作为对照组。采用酶联免疫吸附试验检测血清胱抑素C和血清SF水平，通过计算空腹血糖与空腹胰岛素得出胰岛素抵抗指数（HOMA-IR），分析各组间的差异。并使用Spearman法分析血清胱抑素C、SF、HOMA-IR与T2DM合并肥胖的相关性，通过受试者工作特征（ROC）曲线分析其对T2DM合并肥胖的诊断效能。结果 单纯肥胖组和T2DM合并肥胖组BMI高于对照组和单纯T2DM组（P <0.05）。T2DM合并肥胖组高血压、高血脂症发生率高于对照组（P <0.05）。T2DM合并肥胖组舒张压、收缩压高于对照组和单纯肥胖组（P <0.05）。单纯T2DM组和T2DM合并肥胖组空腹血糖高于对照组和单纯肥胖组（P <0.05）。单纯T2DM组和T2DM合并肥胖组甘油三酯高于对照组（P <0.05）。T2DM合并肥胖组血清胱抑素C、SF和HOMA-IR均高于单纯肥胖组、单纯T2DM组和对照组（P <0.05）。Spearman相关性分析结果显示，胱抑素C水平、SF水平、HOMA-IR指数均与T2DM合并肥胖呈正相关（r_s =0.829、0.771和0.721，均P <0.05）。ROC曲线分析结果显示，胱抑素C、SF、HOMA-IR联合检测时诊断效能最高，曲线下面积为0.989（95% CI：0.976，1.000），敏感性为98.0%（95% CI：0.930，0.995），特异性为93.1%（95% CI：0.863，0.966）。结论 血清胱抑素C、SF及HOMA-IR的提高与T2DM合并肥胖的严重程度相关，可作为评估这一群体代谢紊乱及胰岛素抵抗状态的重要生物标志物。

Abstract:

Objective To investigate the values of serum cystatin C, ferritin (SF) and insulin resistance index (HOMA-IR) in patients with type 2 diabetes mellitus (T2DM) and obesity.Methods The 107 patients with T2DM and obesity hospitalized in the Department of Endocrinology of Anqing Municipal Hospital from January 2022 to May 2024 were included in the study. According to body mass index (BMI) and whether T2DM was diagnosed, they were divided into three groups, including 25 cases in the simple obesity group, 33 cases in the simple T2DM group, and 49 cases in the T2DM with obesity group. Another 40 healthy individuals who underwent health checkups during the same period in the hospital were selected as the control group. The enzyme-linked immunosorbent assay was used to detect serum levels of cystatin C and SF, while HOMA-IR values were calculated using the fasting blood glucose and fasting insulin. The differences in these indicators were compared among the groups. The correlations of serum cystatin C, SF, and HOMA-IR with T2DM with obesity were analyzed by the Spearman method, and the diagnostic efficacy of these indicators for T2DM with obesity was further evaluated by the receiver operative characteristic (ROC) curve analysis.Results The BMI in the simple obesity group and the T2DM with obesity group was higher than that in the simple T2DM group (P < 0.05). The incidences of hypertension and hyperlipidemia in the T2DM with obesity group were higher than those in the control group (P < 0.05). The diastolic and systolic blood pressure of the T2DM with obesity group were higher than those of the control group and the simple obesity group (P < 0.05), while the fasting blood glucose and triglyceride levels of the simple T2DM group and the T2DM with obesity group were higher than those of the control group and the simple obesity group (P < 0.05). The levels of serum cystatin C and SF as well as the HOMA-IR in the T2DM with obesity group were higher than those in all the other groups (P < 0.05). Spearman correlation analysis revealed that the levels of serum cystatin C and SF as well as HOMA-IR were positively correlated with T2DM with obesity (r_s = 0.829, 0.771, and 0.721, all P < 0.05). The ROC curve analysis exhibited that the combined detection of cystatin C, SF, and HOMA-IR yielded the highest diagnostic efficacy, with an area under the ROC curve of 0.989 (95% CI: 0.976, 1.000), a sensitivity of 98.0% (95% CI: 0.930, 0.995), and a specificity of 93.1% (95% CI: 0.863, 0.966).Conclusions The increases in levels of serum cystatin C and SF as well as HOMA-IR are associated with the severity of T2DM with obesity, and they can be used as important biomarkers for assessing the metabolic disorders and insulin resistance in the patients.