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目的研究血清单磷酸腺苷激活蛋白激酶(AMPK)和抵抗素与2型糖尿病(DM)合并胃癌(GC)的关系。方法选择2013年1月至2014年5月就诊的2型DM患者30例(DM组)、DM合并GC患者48例(DM并GC组)及健康人群30例(NC组)为研究对象,ELISA法测定血清AMPK和抵抗素的水平;同时测定空腹血糖、空腹胰岛素、血脂等生化指标;采用稳态模型计算胰岛素抵抗指数(HOMA-IR)。结果 DM组及DM并GC组的抵抗素水平分别为(5.54±1.29)、(6.86±1.65)μg/L,均高于NC组的(3.04±1.49)μg/L(P均<0.01)。DM组及DM并GC组AMPK水平分别为(5.53±0.98)、(3.32±0.90)U/L,均低于NC组的(7.54±0.98)U/L(P均<0.01)。抵抗素与空腹胰岛素及HOMA-IR呈正相关(r=0.620,0.668,P均<0.01),AMPK与空腹胰岛素及HOMA-IR呈负相关(r=-0.790,-0.822,P均<0.01),抵抗素与AMPK呈负相关(r=-0.699,P<0.01);抵抗素和AMPK是HOMA-IR的独立影响因素(β=0.183,P<0.05;β=-0.694,P<0.01);AMPK是DM并GC的保护因素(OR=0.118,P<0.05);抵抗素是DM并GC患者淋巴结转移的危险因素(OR=4.716,P<0.01)。结论 AMPK和抵抗素参与2型DM合并GC的发生及淋巴结转移,有可能作为2型DM合并GC的治疗靶点。
Objective To investigate the relationship between serum AMPK and resistin and type 2 diabetes mellitus (DM) with gastric cancer (GC). Methods Thirty patients with DM type 2 (DM group), 48 patients with DM combined with GC (DM group and GC group) and 30 healthy subjects (NC group) were enrolled in this study from January 2013 to May 2014. ELISA The levels of serum AMPK and resistin were measured. The biochemical indexes such as fasting blood glucose, fasting insulin and blood lipid were also measured. The homeostasis model was used to calculate the insulin resistance index (HOMA-IR). Results The levels of resistin in DM group and DM group were (5.54 ± 1.29) and (6.86 ± 1.65) μg / L, respectively, which were significantly higher than those in NC group (3.04 ± 1.49 μg / L, P <0.01). The levels of AMPK in DM group and DM group were (5.53 ± 0.98) and (3.32 ± 0.90) U / L, respectively, which were all lower than those in NC group (7.54 ± 0.98) U / L (all P <0.01). There was a positive correlation between resistin and fasting insulin and HOMA-IR (r = 0.620,0.668, P <0.01). AMPK was negatively correlated with fasting insulin and HOMA-IR (r = -0.790, -0.822, P <0.01) (R = -0.699, P <0.01). The resistin and AMPK were independent factors of HOMA-IR (β = 0.183, P <0.05; β = -0.694, P <0.01) (OR = 0.118, P <0.05). Resistin was a risk factor for lymph node metastasis in patients with DM and GC (OR = 4.716, P <0.01). Conclusions The involvement of AMPK and resistin in the development of type 2 DM combined with GC and lymph node metastasis may serve as therapeutic targets for type 2 DM combined with GC.