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1、肿瘤坏死因子α和瘦素在肥胖及胰岛素抵抗中的作用?5l4?2005年7月第44卷第7期chinJlnt:』Y.!肿瘤坏死因子OL和瘦素在肥胖及胰岛素抵抗中的作用孙琦杨国华王短【摘要】目的探讨血清TNFot及瘦素在肥胖和胰岛素抵抗中的作用.方法2型糖尿病病人84例,健康对照84例,分别测定血清TNFa,瘦素,血脂,空腹及餐后血糖,血清免疫反应性胰岛素(IRI)水平.并准确测量血压,身高,体重,腰臀围比(WHR).结果肥胖者的TNFa及瘦素显着高于体重正常者,女性的瘦素血清水平高于男性2倍以上.相关分
2、析结果显示,TNFa与HOMA胰岛素抵抗指数(HOMA-IR),WHR,空腹IRI正相关(r值分别为0.43,0.53,0.59,P<0.01),与高密度脂蛋白胆固醇呈负相关(r=一0.35,P<0.01).瘦素与HOMA-IR,空腹IRI呈正相关(r:0.31,0.29,P<0.05),男性的瘦素与WHR显着相关.TNFa与瘦素之间存在显着的正相关(r:0.29,P<0.05).多元逐步回归分析表明,HOMA-IR与TNFa的相关性最强,瘦素次之.血清TNFot水平与空
3、腹血糖呈正相关.结论肥胖者的血清TNFa及瘦素水平与胰岛素抵抗密切相关,高水平的TNFa可能直接作用于脂肪组织调节瘦素的释放,而TNFot和瘦素协同作用诱导胰岛素的分泌,从而导致胰岛素抵抗.【关键词】肿瘤坏死因子;瘦素;肥胖症;胰岛素抗药性TheroleoftunlornecrosisfactorandleptininobesityandinsulinresistanceSUNQi.,vGGuo—hua,,vGHeng.DepartmentofEndocrinology,PekingUnionM
4、edwalCollegeHospital,PekingUnionMedwalCollege.ChineseAcademyofMedwalSciences.Betng10073o.ChinaCorrespondingauthor:SUNQi.Email:sunqi@pumch.0cca【Abstract】0bjectiveToinvestigatetheeffectofTNFotandleptininobesityandinsulinresistance.Methods84patientsofty
5、pe2diabetesmellitusand84nondiabeticpersonswereincludedinthisstudy.Thosetwogroupswerefurtherdividedintosubgroupsaccordingtotheirbodymassindex(BMI).TNFot,leptin,lipidlevel,fastingandpostprandialbloodglucoseandimmunoreativeinsulin(IRI)weremeasured.Blood
6、pressure,bodyheight,bodyweightandthecircumferencesofwaistandhipwerealsodocumented.ResultsThelevelsofTNFaandleptinweresignificantlyhigherintheobesethanthoseinnon-obesesubjects.Serumleptinlevelinwomenwas2timeshigherthanthatinmen.Pearsoncorrelationanaly
7、sisshowedthatTNFawaspositivelycorrelatedtoHOMA.IR.waist.to.hipratio(WHR)andfastingIRI(r=0.43,0.53and0.59,respectively,P<0.01),andnegativelycorrelatedtohigh—densitylipoproteincholesterol(r=一0.35,P<0.01).LeptinwaspositivelycorrelatedtoHOMA—IRandf
8、astingIRI(r=0.31,0.29,P<0.05),whileleptin1eve1inmenwassignificantlycorrelatedtoWHR.TherewasalsoapositivecorrelationbetweenTNFaandleptin(r=0.29,P<0.05).MultiplestepwiseregressionanalysisdemonstratedthatHOMA—IRwasmostcloselycorrelatedwithTNFot.wi
