摘要
目的探讨脂联素、瘦素、前脂肪细胞因子-1(Pref-1)与胰岛素抵抗的关系及联合检测预测糖尿病前期病情进展风险的效能。方法选取2019年1月至2023年1月郑州大学第一附属医院收治的304例糖尿病前期患者进行前瞻性队列研究。根据1年内是否进展为糖尿病分为糖尿病组(62例)、糖尿病前期组(242例),另选同期正常糖耐量人群60例作为对照组。比较三组受检者的基线资料及血清脂联素、瘦素、Pref-1表达水平,采用Pearson法分析血清脂联素、瘦素、Pref-1水平与胰岛素抵抗(IR)的相关性,采用Logistic回归分析血清脂联素、瘦素、Pref-1水平对糖尿病前期病情进展的影响,采用受试者工作特征曲线(ROC)分析血清脂联素、瘦素、Pref-1单独及联合检测对糖尿病前期病情进展风险的预测效能。结果三组受检者的年龄、体质量指数(BMI)、甘油三酯、空腹血糖、胰岛素抵抗指数(HOMA-IR)比较,糖尿病组高于糖尿病前期组,且糖尿病前期组高于对照组,差异均有统计学意义(P<0.05);糖尿病组患者的脂联素、Pref-1分别为(2.82±0.93)mg/L、(0.30±0.10)μg/L,明显低于糖尿病前期组的(6.76±2.17)mg/L、(0.51±0.16)μg/L,且糖尿病前期组患者的脂联素、Pref-1明显低于对照组的(8.45±2.80)mg/L、(0.84±0.27)μg/L,而糖尿病组患者的瘦素为(12.00±2.98)μg/L,明显高于糖尿病前期组的(8.79±2.87)μg/L,且糖尿病前期组患者的瘦素明显高于对照组的(3.56±1.09)μg/L,差异均有统计学意义(P<0.05);脂联素(r=-0.694)、Pref-1(r=-0.853)与HOMA-IR呈负相关(P<0.05),瘦素(r=0.660)与HOMA-IR呈正相关(P<0.05);Logistic回归分析结果显示,年龄、BMI、甘油三酯、空腹血糖、脂联素、瘦素、Pref-1是糖尿病前期患者病情进展的独立影响因素,将年龄、BMI、甘油三酯、空腹血糖进行校正,以脂联素、瘦素、Pref-1作为自变量,脂联素、瘦素、Pref-1仍是糖尿病前期患者病情进展的独立影响因素(P<0.05);ROC曲线分析结果显示,脂联素预测糖尿病前期病情进展风险的曲线下面积(AUC)为0.730,截断值≤3.51 mg/L,敏感度为79.03%,特异度为59.09%,瘦素预测的AUC为0.760,截断值>10.78μg/L,敏感度为67.74%,特异度为73.55%,Pref-1预测的AUC为0.795,截断值≤0.37μg/L,敏感度为80.65%,特异度为65.70%,且联合检测预测糖尿病前期病情进展的AUC为0.904,敏感度为87.10%,特异度为82.23%(P<0.05)。结论血清脂肪因子脂联素、Pref-1与不同糖耐量受损人群IR呈负相关,瘦素与之呈正相关,且联合检测对糖尿病前期病情进展风险具有一定预测价值,可作为临床早期预测病情进展风险的辅助指标。
Objective To explore the relationship between adiponectin,leptin,preadipocyte factor-1(Pref-1)and insulin resistance,and to evaluated the efficacy of combined detection of the three indicators in predicting the risk of progression of prediabetes.Methods A prospective cohort study was conducted on 304 patients with prediabetes admitted to the First Affiliated Hospital of Zhengzhou University from January 2019 to January 2023.According to whether they progressed to diabetes within one year,the patients were divided into diabetes group(62 cases)and prediabetes group(242 cases).In addition,60 people with normal glucose tolerance were selected as the control group.The baseline data and serum adiponectin,leptin,and Pref-1 expression levels were compared among the three groups.The correlation between serum adiponectin,leptin,Pref-1 levels and insulin resistance(IR)was analyzed using Pearson's method.The influence of serum adiponectin,leptin,Pref-1 levels on the progression of prediabetes was analyzed using logistic regression.The predictive efficacy of serum adiponectin,leptin,Pref-1 alone and in combination for the risk of progression of prediabetes was analyzed using receiver operating characteristic(ROC)curve.Results The age,body mass indextes group, the prediabetes group, and the control group, and the differences between any two groups were statistically significantdifferences (P<0.05). The adiponectin and Pref-1 levels in the diabetes group were (2.82±0.93) mg/L and (0.30±0.10) μ g/L, respectively, which were significantly lower than (6.76 ± 2.17) mg/L and (0.51 ± 0.16) μ g/L in the prediabetesgroup, and the levels in the prediabetes group were significantly lower than those in the control group with (8.45±2.80) mg/Land (0.84±0.27) μg/L;the leptin level in the diabetes group was (12.00±2.98) μg/L, which was significantly higher than(8.79±2.87) μg/L in the prediabetes group, and the level in the prediabetes group was significantly higher than that in thecontrol group with (3.56 ± 1.09) μ g/L;the differences were statistically significant (P<0.05). Adiponectin (r=-0.694),Pref-1 (r=-0.853) were negatively correlated with HOMA-IR (P<0.05), and leptin (r=0.660) was positively correlatedwith HOMA-IR (P<0.05). Logistic regression analysis showed that age, BMI, triglycerides, fasting blood glucose, adiponectin,leptin, and Pref-1 were independent factors affecting the progression of prediabetes. Adiponectin, leptin, andPref-1 were still independent factors affecting the progression of prediabetes after adjusting for age, BMI, triglycerides,and fasting blood glucose, (P<0.05). ROC curve analysis showed that the area under the curve (AUC) of adiponectin forpredicting the risk of progression of prediabetes was 0.730, with a cutoff value of ≤3.51 mg/L, a sensitivity of 79.03%,and a specificity was 59.09%. The AUC, cutoff value, sensitivity, and specificity in predicting the risk of progression ofprediabetes was 0.760, >10.78 μ g/L, 67.74% , and 73.55% for leptin;0.795, ≤0.37 μ g/L, 80.65% , and 65.70% forPref-1. The AUC of combined detection of the three indicators for predicting the risk of progression of prediabetes was0.904, with a sensitivity of 87.10% and a specificity of 82.23% (P<0.05). Conclusion Serum adiponectin and Pref-1are negatively correlated with insulin resistance in different groups of people with impaired glucose tolerance, whileleptin is positively correlated with insulin resistance. Combined detection of the three indicators has certain predictivevalue for the risk of prediabetes progression, which can be used as an auxiliary index for early clinical prediction of therisk of disease progression.
作者
冯明
陈素芳
李天艺
FENG Ming;CHEN Su-fang;LI Tian-yi(Department of Geriatric Endocrinology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,Henan,CHINA)
出处
《海南医学》
CAS
2024年第16期2295-2300,共6页
Hainan Medical Journal
基金
2021年度河南省医学科技攻关计划省部共建重点项目(编号:SBGJ202102161)。
