| Objective: The adipose tissue is an important organ of energy storage in human, but recent studies found, the adipose tissue also is an important endocrine organ, adiponectin and retinol binding proteins-4 were newly discovered secreted by adipose tissue. The results show that serum adiponectin and retinol binding concentration in obese, patients with impaired glucose tolerance and atherosclerosis patents is lower than the health. Retinol binding proteins-4 in patients with impaired glucose tolerance and diabetic is higher than health, and with the disease'progress, the concentration of retinol binding proteins-4 can further increased. The adiponectin can anti-inflammatory, anti-atherosclerosis and anti-intimal hyperplasia. we detect the serum concentration of adiponectin,retinol binding proteins-4,insulin,creatine,fasting glucose, blood lipid and urinary albumin excretion rate(UAER) etc,to explore the correlation between adiponectin, retinol binding proteins-4 and insulin resistance, diabetic nephropathy.Methods: Select 90 cases type 2 diabetics were hospitalized in Hebei Medical University Second Hospital and 32 cases healthy controls (groupG1).All type 2 diabetics were divided into three groups according to the urinary albumin excretion rate. Simple type 2 diabetes mellitus group(groupG2),type 2 diabetes mellitus with urinary albumin excretion rate(20~199ug/min,G3),type 2 diabetes mellitus with urinary albumin excretion rate(≥200ug/min,G4),each group have 30 cases. The serum adiponectin, retinol binding proteins-4 and insulin concentration were measured by ELISA. Detected related clinical and chemical indicators. All the data were deal with statistical software packages SPSS 13.0. Data expressed using average addition and subtraction standard deviation. Comparative analysis between the many groups using completely randomized design analysis of variance,and the pair wise comparison was performed with S-N-K.The correlation between two indicators was performed with Pearson. Analysis of multiple variables was performed with linear correlation and multiplies stepwise regression analysis. P<0.05 has statistically significant.Results:1 The concentration of serum adiponectin in group G2,group G3 and group G4 were significantly lower than that in group G1(P<0.05),group G3 higher than group G2(P<0.05),group G4 higher than group G3(P<0.05).The difference among the four groups is still exist.2 The concentration of serum retinol binding proteins-4 in group G2,group G3 and group G4 were significantly higher than that in group G1(P<0.001),group G3 higher than group G2(P<0.05),group G4 higher than group G3(P<0.001).3 The level of BMI in group G2 and group G3 were significantly higher than group G1(P<0.05),group G4 lower than group G2 and group G3(P<0.05).The level of fasting blood glucose and glycated hemoglobin in group G2,group G3 and group G4 were significantly higher than group G1(P<0.05),group G3 and group G4 higher than group G2(P<0.05),group G4 higher than group G3(P<0.05).The level of cholesterol in group G2,group G3 and group G4 were significantly higher than group G1(P<0.05),group G4 lower than group G2 and group G3,but have no significant difference(P>0.05).The level of triglyceride in group G2 and group G3 were higher than in group G1(P<0.05),in group G4 lower than in group G2 and group G3(P<0.05).The level of high density lipoprotein in group G2,group G3 and group G4 were lower than in group G1(P<0.05).The level of serum creatinine in group G3 and group G4 were higher than in group G1(P<0.05,P<0.01),group G4 higher than group G3(P<0.05).The level of fasting insulin in group G2 was higher than in group G1(P<0.05),group G3 and group G4 were lower than group G2(P<0.05),group G3 lower than in group G1,but had no difference(P>0.05),group G4 lower than in group G1(P<0.05).The level of UAER in group G2,group G3 and group G4were higher than in group G1(all P<0.05),group G3 higher than group G2(P<0.01),group G4 higher than in group G3(P<0.01).4 Serum retinol binding proteins-4 level was significantly correlated with serum creatinine, UAER ,fasting blood glucose, glycated hemoglobin,fasting serum insulin and insulin resistance index (r=0.657,p<0.01. r=0.755,p<0.01. r=0.538,p<0.01.r=0.629,p<0.01. r=0.622,p<0.01.r=0.313,p<0.05),and negative correlated with triglyceride(r=-0.213,p<0.05),had no correlation with cholesterol, high density lipoprotein, low density lipoprotein, BMI and the length of the disease. Serum adiponectin level was significantly correlated with serum creatinine, UAER, fasting blood glucose, glycated hemoglobin (r=0.672,p<0.01. r=0.724,p<0.01. r=0.367,p<0.01. r=0.485,p<0.01), and negative correlated with BMI,fasting insulin and insulin resistance index(r=-0.212,p<0.05.r=-0.747,p<0.01. r=-0.625,p<0.01), had no correlation with triglyceride, cholesterol, high density lipoprotein and low density lipoprotein.5 The results of multiply stepwise regression analysis in group G2,group G3 and group G4 is:Use serum adiponectin as variable and use triglyceride, cholesterol, high density lipoprotein,low density lipoprotein,fasting blood glucose,insulin, serum creatinine,insulin resistance index,retinol binding proteins-4,glycated hemoglobin, age and length of disease as arguments, serum creatinine,insulin and retinol binding proteins-4 had linear regression relation(determination coefficients were 0.058,0.036,0.039).Use retinol binding proteins-4 as variable and use triglyceride, cholesterol, high density lipoprotein,low density lipoprotein,fasting blood glucose,insulin, serum creatinine,insulin resistance index,glycated hemoglobin,age and length of disease as arguments, high density lipoprotein,insulin resistance index and serum creatinine, had linear regression relation(determination coefficients were0.032,0.162,0.291).Conclusion:1 The level of serum adiponectin in group G2,group G3 and group G4 were lower than in group G1,with the progress of the diabetes and complications, the concentration of serum adiponectin will increase, maybe this is a protection of the body. In diabetes mellitus group, the relation of serum adiponectin with insulin resistance index is negative which means the adiponectin can improve insulin resistance, it will slow down the progress of the complications. In clinical ,use exogamous adiponectin or through some way that can increase the express of adiponectin to the people whose serum adiponectin are low, maybe this a new way that can restrain the progress of the diabetes mellitus. It is need deeper study.2 The level of serum retinol binding proteins-4 in group G2, group G3 and group G4 were higher than in group G1, with the progress of the diabetes and complications, the concentration of serum retinol binding proteins-4 will significant increase, the relation of serum retinol binding proteins-4 with UAER, insulin resistance index and serum creatinine is positive, which marked the retinol binding proteins-4 is relation to insulin resistance and diabetes mellitus's happen and progress. we can use retinol binding proteins-4 as prognostic factors for diabetic nephropathy. To reduce the concentration of serum retinol binding proteins-4 maybe can improve insulin resistance, treat diabetes mellitus and complications. |
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