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《广州医药》编辑部

广州医药杂志服务号
论著

基于 LightGBM 的代谢综合征患者心脏代谢指数与靶器官损害的关联及性别差异研究

Association between cardiometabolic index and target organ damage in patients with metabolic syndrome based on LightGBM:A study on gender differences

:738-746
 
       目的 利用心脏代谢指数(CMI)和轻量级梯度提升机(LightGBM)模型评估代谢综合征(MetS)患者靶器官损害风险,探究其性别特异性关联,为精准干预提供依据。方法 纳入2022年8月至2025年2月在惠州市第一人民医院住院的132例MetS患者以及健康体检者400例(即对照组,仅作为基线对比参数),以心肾损害、大血管病变为复合靶器官损害终点,选取CMI、年龄等为核心特征;构建LightGBM分类模型(70%训练集、30%测试集分层抽样),并采用100次随机拆分验证得出曲线下的面积(AUC)和95%置信区间(CI)并绘制校准曲线;以AUC评估性能,结合沙普利加性解释算法(SHAP)和偏依赖图(PDP)进行可解释性及性别分层分析。结果 基线对比显示,MetS患者CMI(6.8±2.3)高于对照组(3.2±1.1),靶器官损害(TOD)阳性率(57.6%)高于对照组(12.0%)(P均<0.001);LightGBM模型预测AUC达0.812,CMI为最重要预测特征(相对贡献度31.5%),且CMI与性别交互作用检验差异有统计学意义(P<0.01);CMI与靶器官损害呈非线性S形关联,风险拐点为5.7,高危平台期为7.5;女性风险加速阈值(CMI 5.0)早于男性(CMI 6.5)。结论 以健康人群为对照明确了MetS患者的高CMI水平与高TOD风险特征,LightGBM-SHAP框架明确了CMI的核心预测价值,性别特异性阈值为制定男女个性化早期干预策略提供量化指导,具有良好的临床应用潜力。

    Objective This study aims to use the cardiometabolic index(CMI)and the LightGBM model to assess the risk of target organ damage(TOD)in metabolic syndrome(MetS)patients,explore its gender-specific associations,and provide a basis for precise intervention.Methods MetS patients meeting diagnostic criteria and healthy individuals(the control group,used only as a baseline reference parameter)were enrolled.The composite endpoint of TOD was defined as cardiorenal damage and macro/microvascular lesions.Core features selected included CMI and age.A LightGBM classification model was constructed(70% training set,30% test set with stratified sampling),and 100 random splits were used for validation to generate the area under the curve(AUC) with 95% confidence interval(CI)and draw the calibration curve.Performance was assessed using AUC,combined with the SHAP algorithm and Partial Dependence Plot(PDP)for interpretability and gender-stratified analysis.Results Baseline comparison showed that the CMI level of MetS patients(6.8±2.3)was significantly higher than that of the control group(3.2±1.1),and the positive rate of TOD(57.6%)was significantly higher than that of the control group(12.0%)(both P<0.001).The LightGBM model achieved an AUC of 0.875 in prediction,with CMI as the most important predictive feature(relative contribution of 31.5%),and the interaction test between CMI and gender showed a significant difference(P<0.01).CMI showed a non-linear S-shaped association with TOD,with a risk inflection point at 5.7 and a high-risk plateau at 7.5.Significant gender differences were observed:the threshold for accelerated risk in females(CMI 5.0)was earlier than that in males(CMI 6.5).Conclusions Using healthy individuals as controls clarifies the characteristics of high CMI levels and high TOD risk in MetS patients.The LightGBM-SHAP framework clarifies the core predictive value of CMI.The gender-specific thresholds provide quantitative guidance for formulating personalized early intervention strategies for males and females,demonstrating good potential for clinical application.

专题:体重管理

葛根芩连汤治疗代谢性疾病的分子机制研究进展

Molecular mechanisms of Gegen Qinlian decoction in metabolic diseases

:688-693
 
       葛根芩连汤作为一种传统中药复方,在治疗代谢性疾病方面展现出显著的疗效。随着中草药现代研究方法的进步,逐渐揭示了葛根芩连汤在代谢性疾病中的治疗作用及其分子机制,包括葛根素、黄芩苷、小檗碱等活性成分的抗炎作用。然而,中草药研究领域的新理论和新机制被不断发现,如影响肠道菌群、产生植物外囊泡、中药汤剂成分自组装等,使得对葛根芩连汤作用机制的理解亟待更新。本文旨在综述葛根芩连汤在代谢性疾病中的作用及机制,并结合最新的研究成果,重点分析其在肠道菌群、植物外囊泡和中药自组装领域的相关发现,探讨其潜在的治疗靶点和未来研究方向,为临床应用和基础研究提供指导。
      Gegen Qinlian decoction(GQD),as a traditional Chinese herbal formula,has demonstrated significant efficacy in treating metabolic diseases.With advancements in modern research methodologies for Chinese herbal medicine,the therapeutic effects and molecular mechanisms of GQD in metabolic diseases have been progressively uncovered,including the anti-inflammatory properties of its active components such as puerarin,baicalin,and berberine.However,emerging theories and mechanisms in the field of herbal research,such as modulation of gut microbiota,production of plant-derived extracellular vesicles,and self-assembly of components in herbal decoctions,continuously refine our understanding,highlighting the need to update insights into GQD’s mechanisms of action.This review aims to summarize the roles and mechanisms of GQD in metabolic diseases,integrating the latest research progress with a focus on findings related to gut microbiota,plant-derived extracellular vesicles,and self-assembly phenomena.It further seeks to explore potential therapeutic targets and future research directions,thereby providing guidance for clinical applications and fundamental studies.

论著

血清代谢物影响压疮的因果关系:一项孟德尔随机化研究

Causal evidence of serum metabolites affecting the onset of pressure ulcers:A Mendelian randomization study

:373-379
 
       目的  压疮是指由于组织受压时间过长引起的严重并发症,2025年的数据显示,压疮在活动受限患者中发生率高。机体代谢紊乱可能会引起压疮,但是否与血清代谢物有因果影响,暂不明确。方法   本文运用孟德尔随机化(MR)方法评价血清代谢物与压疮间风险因素,基于MR方法评价血清代谢物和压疮的因果联系,分别纳入由欧洲人群全基因组关联研究(GWAS)。压疮:FinnGen R10,3 167例;血清代谢物:EMBL-EBI数据库16种代谢物数据作为研究样本;筛选条件:工具变量筛选条件[P<5×10-8,连锁不平衡聚类r 2 <0.001,kb=10 000,F统计量>10(公式:F=R2 ×N-2/1-R2 )];主要分析方法:使用(IVW)法,辅助采用加权中位数法(WM)、MR-Egger回归法校验;用Benjamini-Hochberg法进行多重检验校正(FDR<0.05为有统计学意义)。结果  共鉴定出10种代谢物与压疮存在关联(P<0.01),经FDR校正后4种:代谢物18:2/20:4n6的水平升高(P<0.000 2)2-Oxopeptide的作用相反,降低压疮的风险(OR=0.73,95%CI:0.59~0.92,P=0.011);琥珀酸可增加压疮的风险(OR=1.13,95%CI:1.03~1.24,P=0.018);甘氨酸/丙氨酸比值降低压疮风险(OR=0.849,95%CI:0.76~0.93,P=0.022)。稳定性分析证明上述发现是可信的、稳健的(heterogeneity:P>0.05,pleoitropy:P>0.05)。结论  血清代谢物通过调控炎症反应、影响微循环障碍以及干预能量代谢途径,参与压疮的发生发展,可作为构建压疮风险的模型以及制定相关干预策略为压疮评估、治疗、预防提供因果层面的理论依据。
      Objective  Pressure ulcer(PU)is a serious complication caused by prolonged tissue compression.Data of 2025 shows that PUs have a high incidence among patients requiring long-term bed rest.Metabolic disorders may contribute to PU development,but whether serum metabolites causally affect PU risk remains unclear.Methods  this study employed the Mendelian randomization(MR)method to evaluate whether serum metabolites are risk factors for PU.To assess the causal relationship between serum metabolites and PU,data from Genome-Wide Association Studies(GWAS)of European populations were included:PU data from FinnGen R10(3 167 cases)and data on 16 serum metabolites from the EMBL-EBI database.Instrumental variable screening criteria were as follows:P<5×10-8,linkage disequilibrium clustering(r 2 <0.001,kb=10,000),and F-statistic >10(Formula:F=[R2 ×N-2]/[1-R2 ]).The inverse variance weighting(IVW)method was used as the primary analytical approach,supplemented by the weighted median(WM)method and MR-Egger regression for verification.The Benjamini-Hochberg method was applied for multiple test correction(FDR<0.05 was considered statistically significant).Results  A total of 10 metabolites were identified to be associated with PU(P<0.01),and 4 remained significant after FDR correction:elevated levels of metabolite 18:2/20:4n6(P<0.0002);2-Oxopeptide exerted an opposite effect,reducing PU risk(OR=0.73,95%CI:0.59-0.92,P=0.011);succinic acid increased PU risk(OR=1.13,95%CI:1.03-1.24,P=0.018);and the glycine/alanine  ratio  reduced PU risk(OR=0.849,95%CI:0.76-0.93,P=0.022).Stability analysis(PH-TauNE[novel pleiotropy test]) confirmed that the above findings were credible and robust(heterogeneity:P>0.05,pleiotropy:P>0.05).Conclusions  Serum metabolites are involved in the occurrence and development of PU by regulating inflammatory responses,affecting microcirculatory disorders,and interfering with energy metabolism pathways.They can provide causal theoretical basis for constructing PU risk prediction models,formulating relevant intervention strategies,and guiding PU treatment,prevention,and assessment.
论著

不同类型尿结石患者肠道菌群结构与尿酸代谢的相关性研究

Correlation between intestinal flora and uric acid metabolism in different types of urinary stones patients

:1398-1403
 
目的 探讨不同类型尿结石患者肠道菌群结构与尿酸代谢的相关性研究。方法 随机选取2022年5月—2023年5月广州市第一人民医院泌尿外科住院的尿结石患者60例为研究组, 选取同期体检中心健康体检人群30名为对照组,按照结石成分将研究组患者分为尿酸组和非尿酸组, 每组各30例, 所有入选患者均接受结石样本、尿样本、大便样本、血样本的采集, 所有样本经光谱、质谱、基因测序、尿常规及血生化检测 , 比较入选对象的肠道菌群及血尿生化指标变化。结果 尿酸组和非尿酸组患者的血磷(SNK-q=7.970、3.542)、血BUN(SNK-q=5.647、4.756)、血SUA(SNK-q=8.178、3.623)、血SCr(SNK-q=7.300、5.553)、血LPS(SNK-q=13.101、9.705)及24h尿酸(SNK-q=4.462、6.426)水平均高于对照组, 具有统计学意义(P<0.05), 尿酸组和非尿酸组患者的血钙水平低于对照组(SNK-q=3.918/3.047, P<0.05)。非尿酸组患者的血磷、血SUA、血LPS均低于尿酸组, 均有统计学意义(SNK-q=4.428、4.555、3.397, P<0.05)。尿酸组和非尿酸组患者肠道中双歧杆菌数量低于对照组, 差异具有统计学意义(SNK-q=3.754、3.143, P<0.05)。非尿酸组患者肠道中乳酸杆菌数量高于对照组和尿酸组(SNK-q=4.105、3.463, P<0.05), 尿酸组及非尿酸组患者的血尿酸及24 h尿尿酸水平与肠道双歧杆菌数量呈负相关(P<0.05)。结论 肠道双歧杆菌数量对结石患者血尿酸代谢及尿结石形成具有相关性。
Objective To explore the relationship of intestinal flora and uric acid metabolism in different urinary stones patients.Methods From May 2022 to May 2023, 60 patients with urinary stones patients in Guangzhou First People’s Hospital were selected as the study group, and 30 health check-up people in the same period of the medical examination center were selected as the control group.Study group was divided into the uric acid group and the non-uric acid group, 30 cases each group, all patients received stone samples, urine samples, stool samples,blood samples collection, mass spectrometry, gene sequencing, urine routine, blood biochemical detection were performed.Intestinal flora and blood urinary biochemical indicators of the patients were compared.Results The levels of blood phosphorus(SNK-q=7.970, 3.542), blood BUN(SNK-q=5.647, 4.756), blood SUA (SNK-q=8.178, 3.623), blood SCr(SNK-q=7.300, 5.553), blood LPS(SNK-q=13.101, 9.705), and 24-hour urine uric acid (SNK-q=4.462, 6.426)in the uric acid group and the non-uric acid group were all higher than those in the control group,and were statistically significant(P<0.05).The blood calcium levels of the patients in the uric acid group and the non-uric acid group were lower than those in the control group(SNK-q=3.918/3.047, P<0.05).The blood phosphorus, blood SUA and blood LPS levels of the non-uric acid group were all lower than those of the uric acid group, and the differences were statistically significant (SNK-q=4.428, 4.555, 3.397, P<0.05).The number of bifidobacteria in the intestines of patients in the uric acid group and the non-uric acid group was lower than that of the control group,and the differences were statistically significant(SNK-q=3.754, 3.143, P<0.05).The number of lactobacilli in the intestines of patients in the non-uric acid group was higher than that of the control group and the uric acid group(SNK-q=4.105, 3.463, P<0.05).The levels of blood uric acid and 24-hour urine uric acid in the uric acid group and the non-uric acid group were negatively correlated with the number of Bifidobacterium in the intestines(P<0.05).Conclusions The number of intestinal bisidobacteria has a significant correlation with the metabolism of blood uric acid and urinary stones in patients with stones.
综述

大蒜对糖脂代谢调节作用的研究进展

Garlic and its regulatory effects on glucose and lipid metabolism

:472-477
 
大蒜为百合科葱属植物的地下鳞茎,具有药食两用的价值,其含有大蒜素、二烯丙基硫醚、二烯丙基二硫醚、二烯丙基三硫醚、 硫-烯丙基半胱氨酸等多种生物活性成分,具有抗氧化、抗感染、免疫调节、心血管保护、抗癌等作用。不仅如此,大蒜在糖脂代谢的调节中功效显著,且相关机制日益明晰,主要包括保护胰岛β细胞功能、改善胰岛素抵抗、阻止脂肪细胞生长、抑制脂合成代谢及调节肠道菌群分布等。不同的提取工艺可影响大蒜的功效,其提取手段及药效关系值得进一步研究。
Garlic has values of both medicine and food,with rich allicin,diallyl disulfide(DADS),diallyl trisulfide(DATS)and other garlic sulfur contents,which have been found to have multiple effets such as antioxidant,anti-infection,immunomodulatory,cardiovascular protection,anti-cancer,etc.Moreover,numerous studies have demonstrated that garlic plays an important role in the regulation of glycose and lipid metabolism,and the relevant mechanisms are becoming better understood,including protecting pancreatic β cells,improving insulin resistance,preventing the growth of fat cells,inhibiting lipid anabolism and adjusting the distribution of intestinal microflora.Different extraction processes can affect the efficacy of garlic,and further investigations are needed to elucidate the relationship between effective extraction methods and pharmacodynamic properties.
论著

喹硫平联合帕利哌酮治疗精神分裂症疗效及对代谢功能与血清因子的影响

Efficacy of quetiapine combined with paliperidone in the treatment of schizophrenia and its effect on metabolic function and serum factors

:1084-1088
 
目的 针对精神分裂症患者接受喹硫平与帕利哌酮联合治疗对其代谢功能及血清因子的影响。方法 纳入2022年1月—2023年3月驻马店市第二人民医院收治的120例精神分裂症患者,根据住院号进行编号,并通过通过随机抽签方法分为两组,对照组60例应用单一喹硫平治疗,观察组60例应用喹硫平与帕利哌酮联合治疗,对比两组的治疗效果。结果 经治疗,观察组临床总疗效高于对照组(P<0.05);该组各项代谢功能指标均与对照组比较差异无统计学意义(P>0.05);该组各项血清因子测定该结果均高于对照组(P<0.05);该组各项精神症状评分均低于对照组(P<0.05);该组不良反应发生率与对照组比较差异无统计学意义(P>0.05)。结论 采用喹硫平与帕利哌酮联合的方式治疗精神分裂症患者,可以提升临床疗效,对患者各种精神症状及血清因子改善效果更好,虽然药物会对患者代谢功能产生一定的影响,但是联合用药与单独用药的影响情况无差异,未增加不良反应发生率,安全性良好。
Objective To evaluate the combination of quetiapine and paliperidone on metabolic function and serum factors in schizophrenia.Methods A total of 120 patients with schizophrenia admitted to Zhumadian Second People's Hospital from January 2022 to March 2023 were included,numbered according to the hospitalization number,and divided into two groups by random drawing method.Sixty patients in the control group were treated with quetiapine alone,and 60 patients in the observation group were treated with quetiapine combined with paliperidone,and the therapeutic effects of the two groups were compared.Results After treatment,the total clinical efficacy of the observation group was higher than that of the control group,P<0.05;the metabolic function indexes comparison were P> 0.05;the serum factor of observation group was higher,P<0.05;the scores of psychiatric symptoms in the group were all lower than the control group,P<0.05;the incidence of adverse reactions in the observation improve group was not different from the control group,P>0.05.Conclusions Using quetiapine and schizophrenia,can improve clinical curative effect,various mental symptoms and serum factors,although certain effect on patient metabolic function may occur,but did not significantly increase the incidence of adverse reactions,with high safety.
综述

基于浊毒理论探讨代谢综合征病机及治疗

Discussion on pathogenesis and treatment of metabolic syndrome based on turbid toxin theory

:106-111
 
代谢综合征属于中医学“肥胖”“消渴”“脾瘅”等范畴,是以多种代谢异常在同一个体集结出现,包括肥胖、高血糖、血脂异常、高血压以及高尿酸血症等为表现的临床综合征。“浊毒”是由于脏腑功能失常,导致机体产生的生理、病理产物不能及时排出,蕴积体内而化生的致病因素。浊毒致病机体多有面色晦浊、腹胀满、小便浑浊、大便黏腻不爽、黄腻苔、滑数脉等表现。浊毒与代谢综合征的发病机制,在微观和宏观上具有对应性。文章从浊毒与代谢综合征的发病机制出发,对其临床治疗的共同点进行了综述。
Metabolic syndrome falls into the categories of obesity,diabetes and spleen disease in traditional Chinese medicine,and is manifested by various metabolic abnormalities in an individual,including obesity,hyperglycemia,dyslipidemia,hypertension and hyperuricemia. The turbid toxin is a pathogenic factor caused by visceral dysfunction,which leads to the accumulation of physiological and pathological wastes that fail to be eliminated from the body in time. People with turbid toxin are manifested by dull and cloudy complexion,abdominal distension,turbid urine,sticky stool,yellow greasy coating,slippery pulse,etc. The turbid toxin corresponds to the pathogenesis of metabolic syndrome at both micro and macro levels. This paper intends to explore the correlations between the turbid toxin and the pathogenesis of metabolic syndrome and make a review with relevant clinical treatment.
专题论著: 新型冠状病毒肺炎

天津市三级综合医院疫情期间医护人员代谢综合征与高同型半胱氨酸血症的关系及靶器官损害的研究

Study on the relationship of metabolic syndrome and hyperhomocysteinemia and target organ damage among medical staff in a Tianjin third-class general hospital during the pandemic period

:11-16
 
目的 了解疫情期间医护人员代谢综合征(MS)、高同型半胱氨酸血症(HHcy)的患病率、二者关系及靶器官损害。方法 选取2020年1月—2021年11月在天津市某三级综合医院的1 544名医护人员作为研究对象。测量人体指标,测定血液生化、免疫等指标。分析MS及其组分的患病率、HHcy的患病率及靶器官损害。采用χ2检验,比较MS组、HHcy组与对照组靶器官损害的差异。采用Logistic回归模型分析MS与HHcy的关系。结果 三级综合医院医护人员疫情期间MS患病率为23.7%,MS组分:中心性肥胖、高血压/高血压病、高甘油三酯、低高密度脂蛋白和高空腹葡萄糖/糖尿病的患病率分别为49.4%、19.3%、24.3%、0.5%和37%。HHcy的患病率为29.7%。MS组、HHcy组与对照组靶器官损害程度差异有统计学意义(P<0.001)。HHcy与MS无直接相关性。结论 疫情期间医护人员MS和HHcy患病率较高,与对照组相比有明显的靶器官损害,HHcy不是MS的独立危险因素。
Objective To explore the prevalence of metabolic syndrome (MS) and hyperhomocysteinemia (HHcy), their relationship and target organ damage among medical staff during the pandemic. Methods A total of 1 544 medical staff in a third-class general hospital in Tianjin from January 2020 to November 2021 were selected as the object of study. The indexes of human body were measured, and the indexes of blood biochemistry and immunity were detected. The prevalence of MS and its components, the prevalence of HHcy and target organ damage were analyzed. χ2 test was used to analyze the difference of target organ damage among MS group, HHcy group and control group. The relationship between HHcy and MS was analyzed by Logistic regression model. Results The prevalence of MS among medical staff in the third-class general hospital during the pandemic was 23.7%. The prevalence of central obesity, hypertension / hypertension disease, high triglyceride, low high density lipoprotein cholesterol and high fasting plasma glucose/diabetes were 49.4%, 19.3%, 24.3%, 0.5% and 37%, respectively. The prevalence of HHcy was 29.7%. There was significant difference in target organ damage among MS group, HHcy group and control group (P<0.001). There was no direct correlation between HHcy and MS. Conclusions During the pandemic period, the prevalence of MS and HHcy in medical staff were high, and there was obvious target organ damage in those staff compared with the control staff. HHcy is not an independent risk factor of MS.
论著

新疆绝经后女性2型糖尿病LRP5基因rs3736228、rs3781586位点的基因多态性及突变与糖、脂、骨代谢关系的研究

Study on the relationship in genetic polymorphism and mutation of LRP5 gene rs3736228 and rs3781586 and glucose, lipid and bone metabolism in postmenopausal woman with type 2 diabetes in Xinjiang

:6-11
 
目的 观察新疆石河子地区绝经后女性2型糖尿病(T2DM)患者糖、脂、骨代谢特征及骨密度(BMD)情况,探讨该人群中低密度脂蛋白受体相关蛋白5(LRP5)基因rs3736228、rs3781586位点的基因多态性及突变与糖、脂、骨代谢指标的关系。方法 将新疆石河子地区2016年10月—2017年10月社区、医院门诊及住院绝经后女性按照纳入标准和排除标准选取136例为研究对象,根据患者病史、糖耐量实验及骨密度仪测定骨密度分4组,糖耐量正常与骨量正常组(A组),糖耐量正常与骨量异常组(B组),T2DM与骨量正常组(C组),T2DM与骨量异常组(D组)。测定并记录患者年龄、绝经年限等基线资料,计算体质指数(BMI)等,并检测糖代谢指标(空腹血糖等)、骨代谢指标(血Ca等)、脂代谢指标(甘油三酯等)。采用MALDI-TOF-MS法测定LRP5基因该两个位点基因多态性并进行统计分析。结果 ①糖代谢指标:与A组比较,C组、D组FPG、HbA1c均高于A组(P<0.01)。脂代谢指标:与A组比较,B组、D组TG低于A组(P<0.05)。骨代谢指标:与A组比较,B组、D组BMD(L1-4)、BMD(股骨颈)低于A组(P<0.01)。②LRP5基因该两个位点SNP基因分型分布符合Hardy-Weinberg遗传平衡定律(P>0.05);同时,该两个位点不同基因型的分布频率和等位基因频率在组间的比较经Pearson Chi-Square检验后发现暂无显著差异(P>0.05)。③LRP5基因rs3736228位点:A组,与CC型(野生型)相比,CT/TT型(突变型)甘油三酯(TG)降低(P<0.05),BMD(L1-4)降低(P<0.05);C组,与CC型(野生型)相比,CT/TT型(突变型)高密度脂蛋白(HDL-C)升高(P<0.01),磷(P)升高(P<0.05);LRP5基因rs3781586位点:B组,与GG型(野生型)相比,GT/TT(突变型)高密度脂蛋白(HDL-C)升高(P<0.05)。结论 在新疆石河子地区绝经后女性2型糖尿病人群中,LRP5基因rs3736228、rs3781586位点的基因多态性可能与糖代谢无关,但LRP5基因rs3736228位点的突变可能与脂代谢(TG、HDL-C)、骨代谢(P、BMD)有关,rs3781586位点的突变可能与脂代谢(HDL)有关。
Objective To observe the characteristics of glucose, lipid and bone metabolism and bone mineral density (BMD)in postmenopausal women with type 2 diabetes mellitus (T2DM)in Shihezi district of Xinjiang province, and to investigate the relationship in the polymorphism and mutation of rs3736228 and rs3781586 of LRP5 gene and glucose,lipid and bone metabolism indexes in this population. Method A total of 136 postmenopausal Han women, who were related in the outpatient department, community, and hospital after hospitalization in Shihezi district of Xinjiang province from October 2016 to October 2017, were selected as the study subjects by the inclusion criteria and exclusion criteria.According to the patient's medicalhistory, glucosetolerance test results and bone mineral density (BMD), they were divided into 4 groups: normal glucose tolerance and normal bone mass (group A), normal glucose tolerance and abnormal bone mass (group B), type 2 diabetes and normal bone mass (group C), and type 2 diabetes mellitus and abnormal bone mass (group D). Baseline data such as patient's age, menopause years were measured and recorded, and body mass index (BMI)was calculated. Simultaneously, glucose metabolism indicators including fasting blood glucose (FBG, etc), bone metabolism indicators (blood Ca, etc), lipid metabolism indicators(triglycerides, etc)were detected. The polymorphisms of rs3736228 and rs3781586 of LRP5 gene were determined by Maldi-Tof-Ms and those data were analyzed statistically. Results ①Glucose metabolism index: compared with group A: FPG and HbAlc in group C, group D were all higher than group A (P<0.01). Lipid metabolism index: compared with group A, TG in group B and group D was lower than that in group A (P<0.05). Bone metabolism index: compared with group A, BMD (L1- 4)and BMD (femoral neck)in group B and group D were lower than those in group A (P<0.01). ②The distribution of SNP genotypes at rs3736228, rs3781586 of LRP5 conformsed to the Hardy-Weinberg genetic equilibrium law (P>0.05). The distribution frequency and allele frequency of LRP5 genotypes rs3736228, rs3781586 were compared among the groups. Pearson chi-square test showed no significant difference (P>0.05). ③Rs 3736228 locus of LRP5 gene:in group A, compared with CC (wild type), CT/TT (mutated type)triglyceride (TG)decreased (P<0.05), BMD (L1- 4)decreased (P<0.05). In group C, compared with CC (wild type), CT/TT (mutated type)high-density lipoprotein (HDL-C)increased (P<0.05), phosphorus increased (P<0.05). Rs 3781586 locus of LRP5 gene: in group B, compared with GG (wild type), GT/TT (mutated type)high-density lipoprotein (HDL-C)increased (P<0.05).Conclusion In the Xinjiang Shihezi district among postmenopausal women with type 2 diabetes, rs3736228, rs3781586 loci of LRP5 gene polymorphism may be irrelevant to glucose metabolism, but the mutation of rs3736228 of LRP5 gene locus may be related to lipid metabolism and bone metabolism (TG, HDL-C, BMD, P), and the mutation of rs3781586 may be related to lipid metabolism (HDL-C).
论著

绝经前后女性2型糖尿病患者C肽水平与代谢综合征的关系

Relationship between C-peptide level and metabolic syndrome in premenopausal and postmenopausal women with type 2 diabetes mellitus

:76-79
 
目的 分析绝经前后女性2型糖尿病(type 2 diabetes mellitus,T2DM)患者C肽水平与代谢综合征(metabolic syndrome,MS)的关系。方法 选定本院2019年3月—2021年3月接诊的64例绝经前后T2DM患者作为试验组,以及同期门诊体检的64例健康女性作为参照组,检测并比较两组空腹C肽、餐后2 h C肽、血糖指标、血清炎症指标、血脂指标、血压指标,比较两组MS发生率,Pearson分析空腹C肽、餐后2 h C肽与血糖指标、血清炎症指标、血脂、血压的相关性。结果 试验组空腹C肽、餐后2h C肽、餐后2 h 血糖、空腹血糖、白细胞计数、TNF-α、IL-6、LDL-C、甘油三酯、总胆固醇、收缩压、舒张压均高于参照组,试验组HDL-C低于参照组,P<0.05。试验组MS发生率(12.50%)高于参照组(1.56%),P<0.05。空腹C肽、餐后2 h C肽与2 h PG、FPG、WBC、TNF-α、IL-6、LDL-C、TG、TC、SBP、DBP呈正相关性,与HDL-C呈负相关性,P<0.05。结论 绝经前后T2DM患者普遍存在血脂、血压、血糖代谢紊乱及炎症反应,C肽水平增高会增加MS发生率,应当引起临床重视。
Objective To analyze the relationship between C-peptide and metabolic syndrome (MS) in premenopausal and postmenopausal women with type 2 diabetes mellitus (T2DM). Methods A total of 64 premenopausal and postmenopausal T2DM patients in our hospital from March 2019 to March 2021 were included in the experimental group, and 64 healthy women in the same period were selected as the control subjects. Fasting C-peptide, postprandial 2h C-peptide and blood glucose, serum inflammatory factors, blood lipid and blood pressure were detected and compared between the two groups. The incidence of MS was compared between the two groups. The relationship among fasting C-peptide, postprandial 2h C-peptide and blood glucose, serum inflammation, blood lipid and blood pressure were analyzed by Pearson correlation. Results Fasting C-peptide,postprandial 2h C-peptide, 2hPG, FPG, WBC, TNF-a, IL-6, LDL-C, TG, TC, SBP, DBP of the experimental group were higher than those of the control group. HDL-C of the experimental group was lower than that of the control group, P<0.05. The incidence of MS in the experimental group (12.50%) was higher than that in the control group (1.56%), P< 0.05. Fasting C-peptide and postprandial 2h C-peptide were positively correlated with 2hPG, FPG, WBC, TNF-a, IL-6, LDL-C, TG, TC, SBP and DBP, and negatively correlated with HDL-C (P<0.05). Conclusion The metabolic disorder of blood lipid, blood pressure, blood glucose and inflammatory reaction were common in T2DM patients before and after menopause. The increase of C-peptide level would increase the incidence of MS, which should be paid attention in clinic practice.
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