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目的:观察2型糖尿病患者应激状态下血浆脂联素(APN)的变化,及应用罗格列酮(RSG)后对脂联素水平的影响。方法:我科2007年1月～2009年6月住院的2型糖尿病患者124例,合并高血糖应激的84例随机分为A、B两组(各42例),其他40例无急性并发症患者为C组。A、C组在B组降糖治疗基础上加用RSG 4 mg·d~(-1),B组无RSG的降糖治疗。观察治疗前后APN,C反应蛋白(CRP),皮质醇(COR),血糖(BG),糖化血红蛋白(HbA1C)等指标变化。结果:治疗前A、B两组APN浓度明显低于C组(P<0.05),CPR及COR水平则明显高于C组(P<0.05)。治疗后A组APN浓度较前明显升高(P<0.05),且水平高于B组(P<0.05),增加的幅度与C组相比差异无统计学意义(P>0.05);CRP、COR明显低于B组(P<0.05),与C组相比差异无统计学意义。三组BG、HbA1C等水平差异无统计学意义。结论:2型糖尿病合并高血糖应激时APN水平明显减少,CRP、COR等拮抗胰岛素激素水平明显增高。RSG能显著增加高血糖应激状态时APN水平,并不依赖于血糖水平,从而减轻胰岛素抵抗。
Objective: To observe the changes of plasma adiponectin (APN) and the effect of rosiglitazone (RSG) on adiponectin in type 2 diabetic patients under stress. Methods: 124 cases of type 2 diabetes mellitus hospitalized from January 2007 to June 2009 in our department were randomly divided into A and B groups (n = 42), 84 cases were complicated with hyperglycemia. The other 40 cases were without acute complications Symptomatic patients for the C group. Group A and C were treated with RSG 4 mg · d ~ (-1) on the basis of hypoglycemic treatment in group B, and group B was treated with hypoglycemic treatment without RSG. The changes of APN, CRP, COR, BG and HbA1C before and after treatment were observed. Results: Before treatment, the APN concentrations in A and B groups were significantly lower than those in C group (P <0.05). The levels of CPR and COR were significantly higher than those in C group (P <0.05). After treatment, the APN concentration in group A was significantly higher than that in group A (P <0.05), and the level of APN in group A was significantly higher than that in group B (P <0.05). There was no significant difference between the two groups (P> 0.05) COR was significantly lower than the B group (P <0.05), compared with the C group no significant difference. Three groups of BG, HbA1C and other levels showed no significant difference. CONCLUSION: APN levels in type 2 diabetic patients with hyperglycemia were significantly decreased, and the levels of antagonistic insulin hormones such as CRP and COR were significantly increased. RSG can significantly increase the level of APN in hyperglycemic stress state, and does not depend on the blood glucose level, thus reducing insulin resistance.