| 摘要: |
| 目的 探讨肥胖合并黑棘皮病患者中成纤维细胞生长因子21(FGF21)的表达及其与胰岛素分泌特征的关系。方法 选取肥胖合并黑棘皮病患者38例和单纯性肥胖患者35例,以及年龄匹配的正常对照组20例。分别检测各组炎症指标(游离脂肪酸、尿酸、C-反应蛋白)、糖脂代谢指标和胰岛素水平,并采用ELISA法测定血清FGF21水平。结果 肥胖合并黑棘皮病患者组表现为高胰岛素血症和胰岛素抵抗,血清FGF21、空腹胰岛素和胰岛素抵抗指数(HOMA-IR)高于其他两组(P<0.05,P<0.01),胰岛素作用指数(IAI)低于其他两组(P<0.01)。相关性分析显示肥胖患者血清FGF21水平与空腹胰岛素及HOMA-IR正相关(r=0.410, P=0.009; r=0.350, P=0.027),与IAI和体脂率呈负相关(r=-0.615, P<0.001;r=-0.554,P<0.001)。Logistic回归分析显示尿酸水平升高和FGF21升高是肥胖患者合并黑棘皮病的独立危险因素(P=0.008, P=0.020)。结论 肥胖合并黑棘皮病患者在临床上表现为高胰岛素血症和高FGF21水平。FGF21升高与胰岛素抵抗明显相关,而黑棘皮病患者的糖耐量受损较无黑棘皮病的肥胖症患者低,提示FGF21的升高可能对糖代谢有一定保护作用。尿酸和FGF21升高是肥胖症患者合并黑棘皮病的独立危险因素。 |
| 关键词: 成纤维细胞生长因子21 黑棘皮病 肥胖症 尿酸 胰岛素抵抗 |
| DOI：10.16781/j.0258-879x.2016.02.0167 |
| 投稿时间：2015-07-09修订日期：2015-11-07 |
| 基金项目:上海申康慢性病防治项目(SHDC12012303). |
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| Relationship between serum fibroblast growth factor 21 and insulin secretion in obese patients with acanthosis nigricans |
| HUANG Yue-ye,WANG Xing-chun,CHEN Jia-qi,LI Yan,QU Shen* |
(Department of Endocrinology and Metabolism, Shanghai 10th People's Hospital, Tongji University, Shanghai 200072, China
*Corresponding author) |
| Abstract: |
| Objective To investigate the serum level of fibroblast growth factor 21 (FGF21) and its relation with insulin secretion in simple obesity patients with acanthosis nigricants. Methods A total of 35 obese patients (OB group) and 38 obese patients with acanthosis nigricants (AN group) visiting our department were included in this study, and 20 age-matched healthy volunteers were taken as controls. The lipid profile, free fatty acid (FFA), uric acid (UA) and C-reactive protein (CRP) were measured in each group, and the glucose tolerance and insulin secretion were also observed in all participants. Serum FGF21 level was measured by ELISA. Results Acanthosis nigricants was associated with more severe hyperinsulinemia and insulin resistance in obese patients. The levels of FGF21, fasting insulin and homeostasis model of assessment for insulin resistance (HOMA-IR) in AN group were significantly higher than those in the OB and control groups (P<0.05,P<0.01), while the insulin activity index (IAI) of AN was significantly lower than those in the OB and control groups (P<0.01). Correlation analysis showed that serum FGF21 level was positively correlated with fasting insulin and HOMA-IR (r=0.410, P=0.009;r=0.350, P=0.027), while negatively correlated with IAI and body fat percentage (r=-0.615, P<0.001; r=-0.554, P<0.001). Logistic analysis showed that higher level of FGF21 and UA were the independent risk factors for AN in obese patients(P=0.008, P=0.020). Conclusion Obese patients with AN have high serum FGF21 level and hyperinsulinemia, and increased FGF21 level is associated with insulin resistance. Obese patients with AN have a slighter impaired glucose tolerance than simple obese patients, suggesting that increased FGF21 may benefit glycometabolism. Higher FGF21 and uric acid are the independent risk factors for AN in obese patients. |
| Key words: fibroblast growth factor 21 acanthosis nigricans obesity uric acid insulin resistance |
