青年人血清脂蛋白相关磷脂酶A2水平变化与胰岛素抵抗的关系及临床意义

Relation between youth serum lipoprotein-associated phospholipase A2 levels and insulin resistance and its clinical significance

摘要:

目的：检测青年人血清脂蛋白相关磷脂酶A2（lipoprotein-associated phospholipase A2，Lp-PLA2）水平，探讨其与胰岛素抵抗的相关性及其临床意义。方法：选取160名受试者，其中女性87人，男性73人。平均年龄（33.4±1.2）岁。检测其身高、体质量等人体测量学指标及血脂、空腹血糖（fasting plasma glucose，FPG）、空腹胰岛素（fasting insulin，FINS）等生化指标，并用ELISA检测所有受试者血清Lp-PLA2水平。根据体质指数（body mass index，BMI）和口服葡萄糖耐量（oral glucose tolerance test，OGTT）结果，所有受试者正常体质量-正常葡萄糖耐量（normal weight-normal glucose tolerance，NW-NGT）65例，超重肥胖-正常葡萄糖耐（overweight-obesity-glucose tolerance，OB-NGT）50例和超重肥胖2型糖尿病（overweight-obesity-type 2 diabetes mellitus，OB-T2DM） 45例。结果：OB-NGT、OB-T2DM组的Lp-PLA2水平、BMI、FPG、FINS、低密度脂蛋白胆固醇（low density lipoprotein-cholesterol，LDL-C）、超敏C反应蛋白（high sensitivity C-reactive protein，hs-CRP）及胰岛素抵抗指数（homeostasis model assess－ment-insulin resistance index，HOMA-IR）均高于NW-NGT，差异有统计学意义（P＜0.05）。Pearson相关分析显示，HOMA-IR与血清Lp-PLA2水平、BMI、腰围及hs-CRP呈正相关。多元线性逐步回归分析统计显示，HOMA-IR仍是血清Lp-PLA2水平的独立危险因素（t=4.201，P=0.000）。此外，用尤登指数（Youden’s index，YI）来估测最佳界值，YI值最大时，Lp-PLA2值为21.0 ng/ml，是诊断胰岛素抵抗的最佳切点。结论：青年人中，血清Lp-PLA2水平增高与胰岛素抵抗密切相关，是胰岛素抵抗的独立危险因素，对预测胰岛素抵抗的发生具有一定的临床价值。

Abstract:

Objective：To investigate the relation between youth serum lipoprotein-associated phospholipase A2 levels and insulin re－sistance and its clinical significance. Methods：One hundred and sixty subjects were enrolled into this study，including 87 women and 73 men with an average age of （33.4±1.2） years. Anthropometric indicators such as height，weight and biochemical markers such as serum lipid profile，plasma glucose，and serum insulin level were examined. ELISA was used to detect serum lipoprotein-associat－ed phospholipase A2（Lp-PLA2） levels. According to body mass index（BMI） and the results of oral glucose tolerance test（OGTT），we recruited 65 cases of normal weight-normal glucose tolerance（NW-NGT），45 cases of overweight-obesity-normal glucose tolerance （OB-NGT） and overweight-obesity-type 2 diabetes（OB-T2DM） in total. Results：The OB-NGT group and OB-T2DM group had higher Lp-PLA2，homeostasis model assessment-insulin resistance index（HOMA-IR），BMI，low density lipoprotein-cholesterol（LDL-C），fasting insulin（FINS） and high sensitivity C-reactive protein（hs-CRP） levels compared with those of NW-NGT group（all P＜0.05）. As was shown by Pearson correlation analysis，HOMA-IR had a significantly positive correlation with serum Lp-PLA2 level，BMI，hs-CRP and waistline. Multiple linear stepwise regres－sion analysis statistics indicated that HOMA-IR was the inde－pendent factor of serum Lp-PLA2 level（t=4.201，P=0.000）. In addition，we used Youden’s index（YI） to determine the best threshold. YI got its maximum value，when Lp-PLA2 level was 21.0 ng/ml，which therefore was thought to be the best cut-off point for diagnosis of insulin resistance. Conclusion：Increased youth serum Lp-PLA2 level is closely related to insulin resistance，At the same time serum Lp-PLA2 is an independent risk factor of insulin resis－tance，which provides a certain clinical value in predicting the occurrence of insulin resistance.