2型糖尿病患者皮下脂肪面积与空腹C肽水平的相关性研究

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摘要目的探讨2型糖尿病患者空腹C肽水平与皮下脂肪面积变化的特点及相关性。方法纳入2017年10月～2019年11月首都医科大学附属北京潞河医院内分泌代谢与免疫性疾病中心住院的1461例2型糖尿病患者，根据皮下脂肪面积将其分为三组，即T1组＜173.5 cm2，173.5 cm2≤T2组＜223.5 cm2，T3组≥223.5 cm2。T1组506例，T2组482例，T3组473例。比较三组间身高、体重、腰围、空腹C肽水平等各临床指标。采用相关分析分析空腹C肽水平与体脂及代谢指标的相关性，并运用多元回归模型分析空腹C肽水平的独立影响因素。结果三组性别、糖化血红蛋白、空腹血糖、总胆固醇、低密度脂蛋白胆固醇水平以及估算的肾小球滤过率指标比较，差异无统计学意义（P ＞ 0.05）。与T2组比较，T3组患者的年龄偏小，差异有统计学意义（P ＜ 0.05），而T1组和T2组年龄比较，差异无统计学意义（P ＞ 0.05）。与T1组比较，T2组和T3组体重指数、腰围、内脏脂肪面积、舒张压、尿酸指标升高，且T3组高于T2组，差异均有统计学意义（P ＜ 0.05或P ＜ 0.01）。三组间空腹C肽水平比较，差异有统计学意义（P ＜ 0.05）。相关性分析提示皮下脂肪面积与空腹C肽水平呈正相关（r = 0.35，P ＜ 0.01），校正年龄和糖尿病病程后，二者仍呈正相关（r = 0.34，P ＜ 0.01）。在多元线性回归分析中，校正年龄、性别、内脏脂肪面积、糖化血红蛋白等其他混杂因素后，皮下脂肪面积与空腹C肽水平仍呈独立正相关（B = 0.00，β = 0.16，P ＜ 0.01）。结论在2型糖尿病患者中，随着皮下脂肪面积的增加，空腹C肽水平升高，二者呈独立正相关。

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	刘思默柯静安雅欣赵冬

关键词 ： 2型糖尿病, 肥胖, 皮下脂肪面积, 空腹C肽水平

Abstract：Objective To explore the characteristics and correlation between subcutaneous fat area and fasting C peptide level in patients with type 2 diabetes mellitus. Methods A total of 1461 patients with type 2 diabetes mellitus who admitted to the Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University from October 2017 to November 2019 were included. They were divided into three groups according to subcutaneous fat area, namely T1 group < 173.5 cm2, 173.5 cm2 ≤T2 group < 223.5 cm2, and T3 group ≥ 223.5 cm2. There were 506 cases in T1 group, 482 cases in T2 group and 473 cases in T3 group. The clinical indicators of height, weight, waist circumference and fasting C peptide level and other related indices were compared among three groups. Correlation analysis was used to analyze the correlation between fasting C peptide level and body fat, metabolic index, and multiple regression model was used to analyze the independent influencing factors of fasting C peptide level. Results There were no statistically significant differences between three groups in the levels of gender, glycosylated hemoglobin, fasting blood glucose, total cholesterol, low density lipoprotein cholesterin and the indicator of estimated glomerular filtration rate (P ＞ 0.05). Compared with T2 group, the age of T3 group was younger, with statistically significant difference (P ＜ 0.05), while the age of T1 group and T2 group was not statistically significant difference (P ＞ 0.05). Compared with T1 group, the indicators of body mass index, waist circumference, visceral fat area, diastolic blood pressure and uric acid were increased in T2 group and T3 group, while T3 group was higher than T2 group, the differences were statistically significant (P ＜ 0.05 or P ＜ 0.01). Comparison of fasting C peptide levels between the three groups showed statistically significant differences (P ＜ 0.05). Correlation analysis showed that subcutaneous fat area were positively related with fasting C peptide level (r = 0.35, P ＜ 0.01)，and the two were still positively correlated after correction of age and diabetes course (r = 0.34, P ＜ 0.01). In multiple linear regression analysis, there was an independent positive correlation between subcutaneous fat area and fasting C-peptide level after correction for other confounding factors such as age, gender, visceral fat area, and glycosylated hemoglobin (B = 0.00, β = 0.16, P ＜ 0.01). Conclusion In patients with type 2 diabetes, fasting C peptide level increased with the increase of subcutaneous fat area, and the two show an independent positive correlation.

Key words： Type 2 diabetes mellitus Obesity Subcutaneous fat area Fasting C peptide level

基金资助:国家自然科学基金资助项目（81800723）。

通讯作者: 赵冬（1966.5-），女，博士，主任医师，副教授，硕士生导师，首都医科大学附属北京潞河医院内分泌代谢与免疫性疾病中心主任，糖尿病防治研究北京市重点实验室、首都医科大学糖尿病研究所潞河研究室主任；研究方向：脂代谢、糖尿病及其慢性并发症。

作者简介: 刘思默（1985.3-），女，首都医科大学2019级内科学（内分泌与代谢专业）在读硕士研究生；研究方向：糖尿病及其血管并发症、血糖管理。

引用本文:

刘思默柯静安雅欣赵冬. 2型糖尿病患者皮下脂肪面积与空腹C肽水平的相关性研究[J]. 中国医药导报, 2020, 17(18): 76-80,86.
LIU Simo KE Jing AN Yaxin ZHAO Dong. Correlation study between subcutaneous fat area and fasting C peptide level in patients with type 2 diabetes mellitus. 中国医药导报, 2020, 17(18): 76-80,86.

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