胎球蛋白A/脂联素比值在2型糖尿病合并代谢综合征中的价值

doi:10.3969/j.issn.1673-8640.2020.05.004

摘要/Abstract

摘要：

目的探讨胎球蛋白A（AHSG）/脂联素（APN）比值与2型糖尿病（T2DM）合并代谢综合征（MS）的相关性。方法选取新诊断的T2DM患者130例,根据有无合并MS将患者分为单纯T2DM组（61例）和T2DM合并MS组（69例）,另选取体检健康者60名作为正常对照组。收集所有对象的一般资料,同时检测空腹血糖、总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、C反应蛋白（CRP）、空腹胰岛素（FINS）、AHSG及APN水平,计算胰岛素抵抗指数（HOMA-IR）和AHSG/APN比值。采用Spearman秩相关分析评估各项目之间的相关性。采用Logistic回归分析评估T2DM合并MS的危险因素。采用受试者工作特征（ROC）曲线评价各项目辅助诊断T2DM合并MS的价值。结果正常对照组、单纯T2DM组、T2DM合并MS组AHSG及AHSG/APN比值均依次升高,APN依次降低,各组间比较差异均有统计学意义（P<0.05）。Spearman秩相关分析显示,AHSG与腰围、空腹血糖、TG、LDL-C、HOMA-IR、CRP及AHSG/APN比值均呈正相关（P<0.01）,与APN呈负相关（P<0.01）;APN与腰围、体质量指数（BMI）、收缩压、舒张压、TC、AHSG及AHSG/APN比值均呈负相关（P<0.05、P<0.01）,与HDL-C呈正相关（P<0.05）;AHSG/APN比值与年龄无相关性（P>0.05）,与其他项目均相关（P<0.05、P<0.01）。Logistic回归分析结果显示,校正相关混杂因素后,仅AHSG/APN比值为MS发生的危险因素[比值比（OR）=1.051,95%可信区间（CI）为1.015~1.088,P<0.01],APN为保护因素（OR=0.758,95%CI为0.566~0.978,P=0.047）。ROC曲线分析显示,AHSG、APN和AHSG/APN比值辅助诊断MS的曲线下面积（AUC）分别为0.692、0.730、0.806,AHSG/APN比值的诊断效能优于AHSG和APN。结论 AHSG/APN比值能更好地反映T2DM患者的代谢紊乱状态及MS的发生风险,对T2DM合并MS有较好的辅助诊断价值。

关键词: 胎球蛋白A, 脂联素, 2型糖尿病, 代谢综合征

Abstract:

Objective To investigate the relationship between alpha 2-Heremans-Schmid glycoprotein（AHSG） to adiponectin（APN） ratio and type 2 diabetes mellitus（T2DM） complicated with metabolic syndrome（MS）. Methods A total of 130 newly diagnosed patients with T2DM were enrolled,including 61 patients with only T2DM,69 patients with T2DM complicated with MS. A total of 60 healthy subjects were enrolled as control group. The general data of all the subjects were collected. Fasting plasma glucose,total cholesterol（TC）,triglyceride（TG）,high-density lipoprotein cholesterol（HDL-C）,low-density lipoprotein cholesterol（LDL-C）,C-reactive protein（CRP）,fasting insulin（FINS）,AHSG and APN levels were determined,and homeostasis model assessment of insulin resistance（HOMA-IR） index and AHSG/APN ratio was calculated. Spearman rank correlation analysis was used to analyze the relationships among various parameters. Logistic regression analysis was used to evaluate the risk factors of T2DM complicated with MS. Receiver operating characteristic（ROC） curve analysis was performed to evaluate the auxiliary diagnostic values of various parameters for T2DM complicated with MS. Results AHSG and AHSG/APN ratio increased gradually from control group,T2DM group to T2DM complicated with MS group,whereas APN decreased gradually among them（P<0.05）. Spearman rank correlation analysis showed that AHSG was positively correlated with waistline,fasting plasma glucose,TG,LDL-C,HOMA-IR,CRP and AHSG/APN ratio（P<0.01）,and it was negatively correlated with APN（P<0.01）. APN was negatively correlated with waistline,body mass index（BMI）,systolic and diastolic blood pressures,TC,AHSG and AHSG/APN ratio（P<0.05,P<0.01）,and it was positively correlated with HDL-C（P<0.05）. AHSG/APN ratio was correlated with all the parameters（P<0.05,P<0.01） except age（P>0.05）. Logistic regression analysis showed that only AHSG/APN ratio was the risk factor for MS in T2DM patients after adjusting for confounding factors [odds ratio（OR）=1.051,95% confidence interval（CI） 1.015-1.088,P<0.01],and APN was a protective factor of MS（OR=0.758,95%CI 0.566-0.978,P=0.047）. ROC curve analysis indicated the areas under curves（AUC） of AHSG,APN and AHSG/APN ratio in auxiliary diagnosis of MS were 0.692,0.730 and 0.806,respectively,and the diagnostic performance of AHSG/APN ratio was superior to either AHSG or APN. Conclusions AHSG/APN ratio would reflect the metabolic disorder and the risk of MS in T2DM patients,and it could have a auxiliary diagnostic value for T2DM complicated with MS.

Key words: Alpha 2-Heremans-Schmid glycoprotein, Adiponectin, Type 2 diabetes mellitus, Metabolic syndrome

中图分类号:

R446.1

周中卫, 居会祥, 金浩, 陈红梅, 孙明忠. 胎球蛋白A/脂联素比值在2型糖尿病合并代谢综合征中的价值[J]. 检验医学, 2020, 35(5): 414-419.

ZHOU Zhongwei, JU Huixiang, JIN Hao, CHEN Hongmei, SUN Mingzhong. Relationship between alpha 2-Heremans-Schmid glycoprotein to adiponectin ratio and type 2 diabetes mellitus complicated with metabolic syndrome[J]. Laboratory Medicine, 2020, 35(5): 414-419.

图/表 5

参考文献 14

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组别	例数	年龄/岁	性别/例		BMI/（kg/m²）	腰围/cm	收缩压/kPa
组别	例数	年龄/岁	男	女	BMI/（kg/m²）	腰围/cm	收缩压/kPa
T2DM合并MS组	69	51.32±10.16	33	36	26.81±2.69^*#	93.36±8.77^*#	18.97±2.48^*#
单纯T2DM组	61	50.05±9.81	32	29	23.19±2.46	84.22±8.23	18.06±2.34^*
正常对照组	60	49.92±8.75	33	27	22.78±2.85	82.55±7.85	16.55±1.63
组别	舒张压/kPa	空腹血糖/ （mmol/L）	TC/（mmol/L）		TG/（mmol/L）	HDL-C/（mmol/L）	LDL-C/ （mmol/L）
T2DM合并MS组	11.90±1.32^*#	9.08±1.95^*	5.73±1.14^*#		2.68±1.59^*#	1.07±0.21^*	3.20±0.89^*
单纯T2DM组	11.12±1.19^*	8.75±1.84^*	5.21±0.95^*		1.88±1.06^*	1.21±0.33^*	3.12±0.82^*
正常对照组	10.04±1.25	5.13±0.72	4.82±0.84		1.33±0.65	1.46±0.38	2.48±0.69
组别	FINS/ （μIU/mL）	HOMA-IR	CRP/（mg/L）		AHSG/（mg/L）	APN/ （mg/L）	AHSG/APN比值
T2DM合并MS组	19.63±3.92^*#	4.85（3.83~6.51）^*#	4.92（3.78~6.95）^*#		329.8（288.3~382.2）^*#	7.6（6.1~8.3）^*#	43.7（35.9~50.9）^*#
单纯T2DM组	14.06±3.64^*	4.02（2.96~5.04）^*	4.32（3.20~5.77）^*		303.5（248.8~347.7）^*	8.1（7.2~9.2）^*	34.5（28.7~44.2）^*
正常对照组	9.19±2.52	2.13（1.45~2.61）	1.77（1.12~2.58）		249.6（196.2~288.5）	10.0（8.5~10.8）	26.8（17.8~32.5）

组别	例数	年龄/岁	性别/例		BMI/（kg/m²）	腰围/cm	收缩压/kPa
组别	例数	年龄/岁	男	女	BMI/（kg/m²）	腰围/cm	收缩压/kPa
T2DM合并MS组	69	51.32±10.16	33	36	26.81±2.69^*#	93.36±8.77^*#	18.97±2.48^*#
单纯T2DM组	61	50.05±9.81	32	29	23.19±2.46	84.22±8.23	18.06±2.34^*
正常对照组	60	49.92±8.75	33	27	22.78±2.85	82.55±7.85	16.55±1.63
组别	舒张压/kPa	空腹血糖/ （mmol/L）	TC/（mmol/L）		TG/（mmol/L）	HDL-C/（mmol/L）	LDL-C/ （mmol/L）
T2DM合并MS组	11.90±1.32^*#	9.08±1.95^*	5.73±1.14^*#		2.68±1.59^*#	1.07±0.21^*	3.20±0.89^*
单纯T2DM组	11.12±1.19^*	8.75±1.84^*	5.21±0.95^*		1.88±1.06^*	1.21±0.33^*	3.12±0.82^*
正常对照组	10.04±1.25	5.13±0.72	4.82±0.84		1.33±0.65	1.46±0.38	2.48±0.69
组别	FINS/ （μIU/mL）	HOMA-IR	CRP/（mg/L）		AHSG/（mg/L）	APN/ （mg/L）	AHSG/APN比值
T2DM合并MS组	19.63±3.92^*#	4.85（3.83~6.51）^*#	4.92（3.78~6.95）^*#		329.8（288.3~382.2）^*#	7.6（6.1~8.3）^*#	43.7（35.9~50.9）^*#
单纯T2DM组	14.06±3.64^*	4.02（2.96~5.04）^*	4.32（3.20~5.77）^*		303.5（248.8~347.7）^*	8.1（7.2~9.2）^*	34.5（28.7~44.2）^*
正常对照组	9.19±2.52	2.13（1.45~2.61）	1.77（1.12~2.58）		249.6（196.2~288.5）	10.0（8.5~10.8）	26.8（17.8~32.5）

项目	AHSG		APN		AHSG/APN比值
项目	r值	P值	r值	P值	r值	P值
年龄	-0.037	0.678	0.134	0.130	-0.071	0.421
腰围	0.433	<0.01	-0.219	0.012	0.466	<0.01
BMI	0.115	0.194	-0.187	0.033	0.174	0.048
收缩压	0.157	0.074	-0.228	<0.01	0.243	<0.01
舒张压	0.083	0.350	-0.206	0.018	0.175	0.047
空腹血糖	0.277	<0.01	-0.160	0.069	0.317	<0.01
TC	0.171	0.051	-0.191	0.029	0.216	0.014
TG	0.339	<0.01	-0.150	0.089	0.345	<0.01
HDL-C	- 0.130	0.140	0.222	0.011	-0.177	0.044
LDL-C	0.293	<0.01	-0.097	0.272	0.337	<0.01
HOMA-IR	0.327	<0.01	-0.146	0.098	0.355	<0.01
CRP	0.371	<0.01	-0.148	0.092	0.376	<0.01
AHSG			-0.244	<0.01	0.907	<0.01
APN	-0.244	<0.01			-0.565	<0.01
AHSG/APN比值	0.907	<0.01	-0.565	<0.01

项目	AHSG		APN		AHSG/APN比值
项目	r值	P值	r值	P值	r值	P值
年龄	-0.037	0.678	0.134	0.130	-0.071	0.421
腰围	0.433	<0.01	-0.219	0.012	0.466	<0.01
BMI	0.115	0.194	-0.187	0.033	0.174	0.048
收缩压	0.157	0.074	-0.228	<0.01	0.243	<0.01
舒张压	0.083	0.350	-0.206	0.018	0.175	0.047
空腹血糖	0.277	<0.01	-0.160	0.069	0.317	<0.01
TC	0.171	0.051	-0.191	0.029	0.216	0.014
TG	0.339	<0.01	-0.150	0.089	0.345	<0.01
HDL-C	- 0.130	0.140	0.222	0.011	-0.177	0.044
LDL-C	0.293	<0.01	-0.097	0.272	0.337	<0.01
HOMA-IR	0.327	<0.01	-0.146	0.098	0.355	<0.01
CRP	0.371	<0.01	-0.148	0.092	0.376	<0.01
AHSG			-0.244	<0.01	0.907	<0.01
APN	-0.244	<0.01			-0.565	<0.01
AHSG/APN比值	0.907	<0.01	-0.565	<0.01

项目	未校正混杂因素		校正混杂因素后
项目	OR值（95%CI）	P值	OR值（95%CI）	P值
AHSG	1.007（1.004~1.010）	<0.01	1.004（1.000~1.008）	0.081
APN	0.586（0.443~0.776）	<0.01	0.758（0.566~0.978）	0.047
AHSG/APN比值	1.070（1.040~1.102）	<0.01	1.051（1.015~1.088）	<0.01