| Background: Insulin resistance(IR)and reduced islet beta function is the main pathophysiol ogical mechanisms of type 2 diabetes,patients with diabetes has increased dramatically in recent years,how to better relieve Insulin resistance,the improvement of islet function has important sense to delay the progress of diabetes and its complications.The value of gastrointestinal hormone in insulin resistance and islet function decline of type 2 diabetes and get more and more important.Ghrelin,as a kind of gastrointestinal hormone,is the agent of promoting the secretion of growth hormone receptor(growth hormone secretagogue receptor-1a,GHSR-1a),the endogenous ligand can promote growth hormone(GH)releasedin the body,increase the feeding,to enhance the extensive physiological functions,such as the gastrointestinal movement and anti-inflammatory,and at the same time and the glucolipid metabolism and closely related to obesity,according to whether the n-terminal serine residues acyl classified as two forms: acetoxylation Ghrelin(acyl Ghrelin AG)and to acyl Ghrelin(Des-acyl Ghrelin DAG)two forms.Epidemiologic studies show that low concentration of ghrelin is closely related to insulin resistance,and ghrelin gene polymorphism is closely associated with.In recent years,clinical studies have found that the total ghrel in(T-ghrelin)levels and type 2 diabetes and insulin resistance and islet function has certain correlation,but the result is controversial,mainly with AG and DAG in research into the different proportion of different content of the crowd or related,studies have found that ghrelin also closely associated with obesity,and AG in the body,DAG and AG/DAG has certain correlation with obesity.Due to the presence of ghrelin in the body mainly in the form of DAG,about 50% to 90% of t-ghrelin in blood circulation,the T-ghrelin level may be influenced by DAG changes to a large extent.However,the relationship between AG,DAG and AG/DAG in insulin resistance,islet function and obesity is notconclusive.In this paper,through the determination of AG in T2 DM patients and DAG levels,and AG and DAG ratio and T-ghrelin levels,aims to explore the patients with type 2 diabetes insulin resistance,insulin secretion,the relevance of obesity and influence factors,for patients with type 2 diabetes,especially obese patients with type 2 diabetes prevention and treatment to provide new ideas.Research objects and methods: 1.RESEARCH OBJECTS:The patients with type 2 diabetes(T2DM group)who were selected in our hospital from June 2017 to November 2017,and the health patients(NC group)in the same period were selected.2.RESEARCH METHODS:Record all subjects’ age,gender,course of disease,etc.Height、weight、blood pressure were measured.The tatal cholesterol、triglyceride、high-density lipoprotein cholesterol、low-density lipoprotein cholesterol、HbA1c、fasting plasma glucose、fasting insulin、fasting C-peptide in each subject were detected.Plasma glucose and serum insulin were measured at 30,60,120,180 min during the steamed bread test;Meanwhile,the visceral adipose tissue(VAT)and subcutaneous adipose tissue(SAT)of patients with type 2 diabetes were detected;The AG and DAG levels were tested by Enzyme-linked immunosorbent a ssay(ELISA).Body mass index(BMI),tatal ghrelin,AG/DAG,homeostasis model assessment of insulin resistance index(HOMA-IR),homeostasis model assessment of insulin sensitivity index(HOMA-IS),homeostasis model assessment of β cell function(HOMA-β),early phase islet sectetion index(△I30/△I60)、later phase islet sectetion function(AUCI60-120/G60-120)were calculated.Results 1.Comparison of general clinical data:There were no significant difference in Age、blood pressure、TC、LDL-C between two groups(P<0.05).Compared with NC group,the TG、BMI、Hb A1c、FPG、FINS were significantly higher(P<0.05),while HDL-C、F-C-p were significantly lower in T2 DM group(P<0.05).2.Comparison of IR and islet function:Compared with NC group,HOMA-IR is significantly higher and HOMA-IS、HOMA-β is significantly Lower(P<0.05).3.Comparison of different ghrelin forms:There was no significant different in AG between two groups(P>0.05).Compared with NC group,DAG、T-ghrelin were significantly lower and AG/DAG was significantly higher in T2 DM group(P<0.05).In T2 DM group,compared with BMI≥25 kg/m2 group,AG was significantly higher and DAG、T-ghrelin were significantly lower in BMI<25kg/m2(P<0.05)4.Correlation analysis: In T2 DM group,There was a positive correlation between AG and FPG(P<0.05),Meanwhile,there was a negative correlation between DAG、total ghrelin and BMI、FINS、F-C-p、HOMA-IR、VAT and SAT,while there was a positive correlation with HOMA-IS(P<0.05).There were positive between AG/DAG and BMI、FPG、FINS、HOMA-IR、SAT,while negative correction with HOMA-IS 、AUCI60-120/G60-120(P<0.05).5.Multivariate linear regression analysis: In T2 DM group,AG/DAG was the independent influence factor of HOMA-IR、AUCI60-120/G60-120(P<0.05):T-ghrelin was the independent influence factor of HOMA-β(P<0.05);BMI was the independent influence factor of HOMA-IS(P<0.05).FPG was the independent influence fact or of AG level(P<0.05),while FINS and BMI were the independent influence factors of DAG、total ghrelin(P<0.05),HOMA-IR and BMI were the independen t influence factors of AG/DAG(P<0.05).Meanwhile,there were no effect of ghrelin with early phase islet sectetion function(P>0.05).Conclusions 1.In T2 DM patients,the level of DAG、total ghrelin is significantly lower than NC group,while AG/DAG in higher,indicates that ghrelin is closely related to T2 DM.2.In T2 DM group,there was a negative correlation between DAG、T-ghrelin and HOMA-IR,while there was a positive correlation between AG/DAG and HOM A-IR,Moreover,the AG/DAG was independent influencing factors for HOMA-IR,suggesting that intervening the ratio of AG and DAG can improve insulin resistant.3.In T2 DM group,there was a negative correlation between AG/DAG and AUC I60-120/G60-120,AG/DAG was independent influencing factor for AUCI60-120/G60-120,and T-ghrelin was independent influencing factor of HOMA-β,while there was n o relationship between AG、DAG and islet fuction.4.In T2 DM patients,there was negative correlation between DAG、T-ghrelin and VAT、SAT,while there was appositive correlation between SAT and AG/DAG.In over weight/obse T2 DM patients,the AG and AG/DAG were significantly higher than that of normal weight T2 DM patients,and DAG、T-ghrelin were significantly lower than normal weight T2 DM patients,suggesting that the intervention of AG/DAG could provide a new idea for the treatment of obesity T2 DM patients. |
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