摘要
目的探讨慢性阻塞性肺疾病(COPD)与胰岛素抵抗的相关性及其临床意义。方法纳入稳定期COPD患者作为研究对象,并设健康体检者作为对照组。COPD患者行肺功能检查,根据《慢性阻塞性肺疾病诊治指南》(2007年修订版)判断严重程度。清晨空腹采静脉血检测空腹血糖(FBG)、血脂、纤维蛋白原(Fb)、C反应蛋白(CRP)、空腹胰岛素(FIN)及肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6),计算空腹血糖和胰岛素乘积的倒数即胰岛素敏感指数(ISI),分析各参数之间的相关性。结果共纳入稳定期COPD患者121例,健康对照组40例。COPD患者中轻度22例,中度28例,重度34例,极重度37例。COPD组与对照组比较,FBG和FIN明显增高[(5.53±1.40)mmol/L比(4.33±0.64)mmol/L,(9.69±3.71)mIU/L比(7.15±1.50)mIU/L,P<0.05],ISI明显降低(-3.88±0.54比-3.40±0.28,P<0.05)。COPD组血清CRP、Fb、TNF-α、IL-6水平明显高于对照组(P<0.05)。随着COPD严重度分级级别的升高,血清CRP、Fb、TNF-α、IL-6水平呈进行性升高。直线相关分析表明,COPD严重度分级与ISI呈显著负相关(r=-0.512,P<0.01),与Fb、CRP、TNF-α、IL-6均呈显著正相关(r分别为0.710、0.600、0.708、0.707,P<0.01),ISI与Fb、CRP、TNF-α、IL-6均呈负相关(r分别为-0.384、-0.240、-0.298、-0.396,P<0.01)。结论 COPD患者存在高胰岛素血症及胰岛素抵抗,且COPD病情越重,胰岛素水平越高,胰岛素敏感性越低。
Objective To investigate the clinical significance of insulin resistance （IR） in chronic obstructive pulmonary disease （COPD）. Methods Patients with stable COPD were recruited while healthy volunteers were enrolled as control. The diagnosis and severity assessment were made according to chronic obstructive pulmonary disease diagnosis and treatment guideline （revised edition 2007 ）. Fasting serum levels of glucose （ FBG）, insulin （ FIN）, blood lipids, fibrinogen, C-reactive protein （ CRP）, tumor necrosis factor （TNF-ct） , and interleukin-6 （IL-6） were measured. The degree of IR was calculated by IAI （ IAI = 1/ FBG x FIN）. The relationship of IR with COPD severity and above parameters was analyzed. Results A total of 121 subjects with COPD were enrolled in which 22 cases of mild COPD,28 cases of moderate COPD, 34 cases of severe COPD, and 37 cases of extremely severe COPD. The levels of FBG and FIN were significantly higher in the COPD group than those in the normal control group （P 〈 0. 05）. ISI in the COPD patients was higher than that in the controls （ - 3. 88 ± 0. 54 vs. - 3.40 ± 0. 28, P 〈 0. 05 ）. The levels of CRP, fibrinogen, TNF-α, and IL-6 were significantly higher in the COPD group than those in the control group （P 〈 0. 05 ）. The levels of CRP,TNF-α and IL-6 increased progressively with the severity of COPD. There was a negative correlation between ISI and the severity of COPD （r = -0. 512, P 〈 0. 01 ）, positive correlations of CRP, fibrinogen ,TNF-α and IL-6 levels with COPD severity, respectively（ r =0. 710,0. 600,0. 708,0. 707 ,all P 〈0. 01 ） ,and negative correlations of ISI with the levels of CRP,fibrinogen,TNF-α and IL-6 （ r = - 0. 384, - 0. 240, - 0. 298, - 0. 396, all P 〈 0. 01 ）, respectively. Conclusion There is an increase in fasting serum insulin and insulin resistance in patients with COPD compared with healthy subjects, which deteriorates with severity of COPD.
出处
《中国呼吸与危重监护杂志》
CAS
2012年第5期422-427,共6页
Chinese Journal of Respiratory and Critical Care Medicine
