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目的观察2型糖尿病(T2DM)及代谢综合征(MS)中肿瘤坏死因子α(TNF-α)及高敏C反应蛋白(hsCRP)的变化,并探讨其临床意义。方法选择新诊单纯T2DM患者48例,MS患者51例及健康人对照(NC)组20名,分别测定BMI、WC、WHR、血压、血脂、TNF-α及hsC-RP,行OGTT、胰岛素释放试验(IRT)。用HOMA-β评估基础胰岛素分泌功能,用糖负荷后30min血浆胰岛素及葡萄糖的净增值之比(△I_(30)/△G_(30))评估胰岛素早期分泌相,用HOMA-IR评估胰岛素的敏感性。结果直线相关分析显示BMI、WC、TG及HOMA-IR与TNF-α呈明显正相关,而△I_(30)/△G_(30)及H()MA-β与TNF-α呈明显负相关(P均<0.05)。HOMA-β在T2DM组中显著降低,而MS组则无明显改变;△I_(30)/△G_(30)在T2DM及MS组中均显著降低;HOMA-IR在两组中均显著增高(P均<0.01)。上述胰岛素分泌功能的变化TNF-α增高组较TNF--α正常组更为明显(P<0.05)。结论在T2DM及MS患者中,TNF-α不仅加重胰岛素抵抗,且对胰岛素基础分泌及糖负荷后早期分泌相也具有损害作用。
Objective To observe the changes of tumor necrosis factor α (TNF-α) and high-sensitivity C-reactive protein (hsCRP) in type 2 diabetes mellitus (T2DM) and metabolic syndrome (MS) Methods 48 newly diagnosed T2DM patients, 51 MS patients and 20 normal control subjects were enrolled in this study. BMI, WC, WHR, blood pressure, blood lipids, TNF-α and hsC- Test (IRT). The basal insulin secretion was evaluated by HOMA-β, the early phase of insulin was evaluated by the ratio of the net value of plasma insulin and glucose at 30min after glucose load (△ I_ (30) / △ G_ (30)), Sensitivity. Results The linear correlation analysis showed that BMI, WC, TG and HOMA-IR were positively correlated with TNF-α, while △ I_ (30) / △ G_ (30) and H () MA-β were negatively correlated with TNF- (P <0.05). HOMA-β was significantly decreased in T2DM group and no significant change in MS group; △ I_ (30) / △ G_ (30) was significantly decreased in both T2DM and MS groups; HOMA-IR was significantly increased in both groups P <0.01). The above changes in insulin secretion TNF-α increased compared with TNF - α normal group (P <0.05). Conclusion In T2DM and MS patients, TNF-α not only aggravates insulin resistance, but also has a detrimental effect on basal insulin secretion and early secretory phase after glucose load.