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目的探讨2型糖尿病患者中合并糖尿病足者与胰岛素抵抗的关系,并分析其与血浆肿瘤坏死因子-α(TNF-α)及纤溶酶原激活剂抑制物-1(PAI-1)含量关系。方法研究80例2型糖尿病患者,其中35例糖尿病足患者作为病例组,45例无足部病变的糖尿病患者作为对照组。所有研究对象均检测空腹血糖、胰岛素、血脂。采用酶联免疫吸附双抗体夹心法(ELISA)原理定量测定血浆TNF-α和PAI-1含量。胰岛素抵抗指数(HOMA-IR)=FPG×FIns/22.5。结果糖尿病足患者的HOMA-IR显著高于无糖尿病足的患者(P<0.05)。采用相关分析发现,血浆PAI-1及TNF-α水平与HOMA-IR呈正相关(P<0.01)。多元回归分析显示血浆PAI-1、TNF-α水平、糖化血红蛋白(HbAlc)、体重指数(BM I)及低密度脂蛋白(LDL)是影响2型糖尿病足患者胰岛素抵抗的主要危险因素。结论糖尿病足患者存在着更严重的胰岛素抵抗,血浆PAI-1及TNF-α水平与HOMA-IR具有的正相关性,提示PAI-1及TNF-α等炎性因子参与胰岛素抵抗在糖尿病足的发病过程中起到一定的作用。
Objective To investigate the relationship between type 2 diabetes mellitus (T2DM) and insulin resistance in patients with type 2 diabetes mellitus (T2DM) and analyze its relationship with plasma levels of tumor necrosis factor-α (TNF-α) and plasminogen activator inhibitor-1 . Methods 80 patients with type 2 diabetes mellitus were studied. 35 patients with diabetic foot were selected as the case group and 45 patients without diabetic foot disease as control group. All subjects were tested fasting blood glucose, insulin, blood lipids. The contents of TNF-α and PAI-1 in plasma were quantitatively determined by enzyme-linked immunosorbent assay (ELISA). Insulin Resistance Index (HOMA-IR) = FPG × FIns / 22.5. Results HOMA-IR in patients with diabetic foot was significantly higher than those in patients without diabetic foot (P <0.05). Correlation analysis showed that plasma PAI-1 and TNF-α levels were positively correlated with HOMA-IR (P <0.01). Multivariate regression analysis showed that plasma levels of PAI-1, TNF-α, HbAlc, BMI and LDL were the major risk factors of insulin resistance in patients with type 2 diabetic foot. Conclusion There is more serious insulin resistance in patients with diabetic foot, and there is a positive correlation between plasma PAI-1 and TNF-α and HOMA-IR, suggesting that inflammatory factors such as PAI-1 and TNF-α are involved in insulin resistance in diabetic foot Pathogenesis plays a role.