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目的:检测不同糖耐量个体血浆血管内皮生长因子B(vascular endothelial growth factor-B,VEGF-B)水平,探讨VEGFB与糖脂代谢及胰岛β细胞第一时相分泌功能的关系。方法:选取45例新诊断2型糖尿病患者(type 2 diabetes mellitus,T2DM),37例糖调节受损个体(impaired glucose regulation,IGR),39例正常糖耐量个体(normal glucose tolerant,NGT),行静脉葡萄糖耐量试验,并检测血糖、胰岛素、糖化血红蛋白(hemoglobin A1c,Hb A1c),血脂4项等。ELISA法测定空腹血浆VEGF-B水平,酶法测定空腹游离脂肪酸(free fatty acids,FFA)水平。计算急性胰岛素反应(acute insulin response,AIR)、0~10 min胰岛素曲线下面积(area under the curves,AUC)、葡萄糖处置指数(glucose disposition index,GDI)评估β细胞第一时相分泌功能,稳态模型评估β细胞功能(homaβcell function,HOMA-β)及胰岛素抵抗(homeostasis model assessment of insulin resistance,HOMA-IR)。结果:T2DM组和IGR组血浆VEGF-B水平明显高于NGT组(P=0.000、0.004),且在T2DM组中最高;VEGF-B与AIR、AUC、GDI、HOMA-β显著负相关(P=0.006、0.005、0.010、0.000),与FPG、2h PG、Hb A1c、FINS、TG、FFA、HOMA-IR显著正相关(FINS,P=0.001;余P=0.000)。多项logistic回归分析显示,三分位后,与低水平的血浆VEGF-B(<145.59 pg/ml)相比,更高VEGF-B水平时[145.59 pg/ml~180.07 pg/ml,OR=3.55(95%CI=1.05~12.02);>180.07 pg/ml,OR=3.64(95%CI=1.16~11.42)]β细胞第一时相胰岛素分泌功能减退的可能性更大。进一步控制TG和FFA后,上述相关关系消失(P>0.05)。结论:2型糖尿病患者血浆VEGF-B水平升高,血浆VEGF-B水平与糖脂代谢、胰岛β细胞第一时相分泌功能密切相关,VEGF-B可能参与2型糖尿病的发生发展。
OBJECTIVE: To detect the level of vascular endothelial growth factor-B (VEGF-B) in different glucose tolerance individuals and to explore the relationship between VEGFB and glucose and lipid metabolism and the first phase secretion of pancreatic β cells. Methods: Forty-five patients with type 2 diabetes mellitus (T2DM), 37 impaired glucose regulation (IGR), 39 normal glucose tolerant (NGT) Venous glucose tolerance test and blood glucose, insulin, hemoglobin A1c (Hb A1c), blood lipid 4 and so on. Fasting plasma VEGF-B levels were measured by ELISA and free fatty acids (FFA) levels by enzyme-linked immunosorbent assay. The acute insulin response (AIR), 0 ~ 10 min area under the curve (AUC) and glucose disposition index (GDI) were used to evaluate the first phase secretory function of β cells. HOMA-β and homeostasis model assessment of insulin resistance (HOMA-IR). Results: The plasma levels of VEGF-B in T2DM group and IGR group were significantly higher than those in NGT group (P = 0.000,0.004), and were the highest in T2DM group. VEGF-B was negatively correlated with AIR, AUC, GDI and HOMA- = 0.006,0.005,0.010,0.000), which was significantly and positively correlated with FPG, 2h PG, Hb A1c, FINS, TG, FFA and HOMA-IR (FINS, P = 0.001; Multiple logistic regression analysis showed that, at the third quartile, higher levels of VEGF-B compared with low levels of plasma VEGF-B (<145.59 pg / ml) [145.59 pg / ml to 180.07 pg / ml with OR = 3.55 (95% CI = 1.05 ~ 12.02);> 180.07 pg / ml, OR = 3.64 (95% CI = 1.16 ~ 11.42)] The beta cells were more likely to have the first phase insulin secretion dysfunction. After further control of TG and FFA, the above relationship disappeared (P> 0.05). CONCLUSION: The plasma VEGF-B level is elevated in patients with type 2 diabetes. The level of plasma VEGF-B is closely related to the glucose and lipid metabolism and the first phase secretion of pancreatic β-cells. VEGF-B may be involved in the development of type 2 diabetes mellitus.