肥胖相關之細胞激素與非糖尿病女性胰島素阻抗之關係

Relationship between adipocytokines and insulin resistance in non-diabetic women

李純瑩(Chun-Ying Lee)

指導教授 ： 李建宏

高雄醫學大學/健康科學院/公共衛生學研究所/碩士(2007年)

https://doi.org/10.6832/KMU.2007.00031

摘要

研究背景: 肥胖是胰島素阻抗以及第二型糖尿病的重要危險因子。最近發現造成肥胖的脂肪細胞會分泌數種物質，通稱為「脂肪細胞激素」，可能與肥胖所造成的疾病有關。本篇研究在探討針對非糖尿病的女性，脂肪細胞激素與胰島素阻抗以及葡萄糖不耐症之間的關係。
研究材料與方法: 本研究共收集190位女性。合於收案的條件包括:沒有使用可能影響血糖、血壓、及血脂肪的個案、非糖尿病患者、並且體重在進入研究的六個月內體重變化少於5公斤。所有個案接受簡單的問卷調查，並且至少空腹8小時後接受抽血檢查，包括血糖、膽固醇、三酸甘油脂、高密度脂蛋白、胰島素、以及脂肪細胞激素(leptin and adiponectin)，所有個案接進行葡萄糖耐受試驗，測量血壓，並且測量身高、體重、腰臀圍、以及體脂率。計算HOMA-IR作為胰島素阻抗的指標。將收集到的變項進行統計分析，決定胰島素阻抗與脂肪細胞激素的關係。
結果: 在控制了相關的危險因子後，leptin和adiponectin與胰島素阻抗的程度有獨立的顯著相關，其中leptin與胰島素阻抗為正相關(b=0.03，p=0.036)，adiponectin與胰島素阻抗為負相關(b=-0.09, p=0.001)。adiponectin與二小時血糖值有負向的關係(b=-1.87, p<0.0001)，並且與是否有「葡萄糖不耐症」有顯著相關(OR(95%C.I.)=0.78(0.67-0.92))，leptin則與二小時血糖值以及是否出現胰島素阻抗無顯著統計相關。
結論: 不論個案肥胖的程度，leptin和adiponectin與胰島素阻抗的程度有顯著的關係，其中leptin越高，胰島素阻抗的程度越高；adiponectin的濃度越高，胰島素阻抗的程度則越低。另外，不論個案的肥胖程度，adiponectin與二小時血糖值有相反的關係，並且adiponectin越低，個案出現的機會越高。因此進一步推論，低的adiponectin濃度可能可以當作進一步預測個案發生「葡萄糖不耐症」以及第二型糖尿病的一個指標。

關鍵字

肥胖 ； 胰島素阻抗 ； 脂肪細胞激素 ； adiponecitn ； leptin

並列摘要

Background: Obesity is a well known risk factor of insulin resistance and type II diabetes. Adipocyte-derived proteins had been discovered recently and might contribute to the pathomechanism between obesity and insulin resistance. This study investigated the association between adipocyte-derived proteins (leptin and adiponectin), insulin resistance and impaired glucose tolerance in non-diabetic women.
Methods: One hundred ninety women were recruited from the Obesity Clinic at Kaohsiung Medical University Hospital, Taiwan, between February 2003 and February 2004. Eligible subjects were those who did not have diabetes or not taking medications that would affect glucose, blood pressure, or lipid metabolism. All participants completed a simple questionnaire on their medication history and lifestyle characteristics. Fasting glucose, total cholesterol, HDL-cholesterol, TG, leptin, adiponectin, and fasting insulin level were collected after an overnight fast. Two-hour glucose level after OGTT was obtained. HOMA-IR was calculated as the index of insulin resistance. BMI, waist-to-hip ratio and percent body fat were measured for analyzing the relationship between obesity, insulin resistance and adipocytokines.
Results: In the multiple regression analysis, it showed that leptin and adiponectin were independently associated with HOMA-IR and fasting insulin concentration but in divergent direction after controlling for potential confounding factors; leptin was positively associated with HOMA-IR (b=0.03，p=0.036) and fasting insulin concentration (b=0.16, p=0.009), while adiponectin was negatively associated with HOMA-IR (b=-0.09, p=0.001) and fasting insulin concentration (b=-0.36, p=0.001). Adiponectin was associated with risk of impaired glucose tolerance (OR (95%C.I) =0.78(0.67-0.92)), but leptin was not associated with impaired glucose tolerance after controlling for potential confounding factors (OR (95%C.I) =1.01(0.95-1.08)).
Conclusions: Leptin and adiponectin were both associated with insulin resistance and hyperinsulinemia independent of obesity, suggesting that leptin and adiponectin may be involved in the pathophysiologic of insulin resistance and hyperinsulinemia independent of obesity. Adiponectin was negatively associated with 2-hr glucose levels and impaired glucose levels, suggesting that low levels of adiponectin might be associated with developing impaired glucose tolerance and type 2 diabetes.

並列關鍵字

obesity ； insulin resistance ； adipocytokines ； adiponectin ； leptin

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