| Background Fibroblast growth factor(FGF-21)is a new kind of factor that can positively regulate glucolipid metabolic.In some metabolic diseases such as diabetes and obesity,FGF-21 can help to increase insulin sensitivity,improve glucose tolerance,adjust the energy metabolism and lipid metabolism and weight loss.Exenatide,one of glucagon-like peptide-1 receptor analogues,is skilled in management of blood glucose and weight.So,does FGF-21 participate in the progress of exenatide treatment? There is still a lack of relevant literature reports.Objective1.To observe the levels of serum fibroblast growth factor 21(FGF-21)in obese patients with type 2 diabetes mellitus(T2DM),and analyze the correlation between FGF-21 and clinical metabolic indices in Exe group.2.To observe the effect of exenatide on FGF-21 level in Exe group before and after Exenatide treatment,and analyze the correlation between the change of FGF-21 and the change of clinical metabolic indices,so that to explore the role of FGF-21 in the mechanism in reducing blood glucose and weight loss.Methods1.45 obese patients with T2 DM who unable to achieve glycemic control with metformin or sulfonylurea drugs for at least 3 months in outpatients and inpatients of our department were selected as Exe group,and 45 normal cases were selected as NC group.Exe group were treated with exenatide 5ug then 10 ug twice-daily for 4 and 12 weeks.2.Weight,body mass index(BMI),waist circumference,hip circumference,waist hip ratio(WHR),systolic blood pressure(SBP),diastolic blood pressure(DBP),fasting plasma glucose(FPG),hemoglobin A1c(Hb A1c),fasting insulin(FINS),homeostasis model assessment of insulin resistance(HOMA-IR),homa-beta cell function index(HOMA-?),triglycerides(TG),total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C)and high density lipoprotein cholesterol(HDL-C)of Exe group before and after treatment and NC group were measured.Serum FGF-21 levels were measured by ELISA.The change of FGF-21 and the correlations of FGF-21 levels with above indices were analyzed.Results1.The level of serum FGF-21 of obese patients with T2 DM was significantly higher than controls(t=2.461,P<0.05),and serum FGF-21 was found to correlate positively with weight,BMI,FPG,HOMA-IR,TG(r=0.428,0.514,0.551,0.660,0.634,P<0.01),waist,Hb A1 c,FINS(r=0.377,0.341,0.375,P < 0.05).Multiple stepwise regression analysis showed that HOMA-IR and TG(?=0.552 ? 0.520,P < 0.01)were the independent influencing factors of serum FGF-21 level of obese patients with T2 DM.2.After 16 weeks of exenatide treatment,weight,BMI,waist,FPG,Hb A1 c,WHR,HOMA-IR(t=5.520,5.832,4.717,5.251,9.323,Z=3.386,2.566,P<0.01),DBP,TG and serum FGF-21(t=2.391,2.362,2.400,P<0.05)of Exe group were significant decreased and HOMA-?(t=-2.835,P<0.01),HDL-C(t=-2.251,P<0.05)were significant increased than before.The change of FGF-21 before and after exenatide treatment was found to correlate positively with the change of HOMA-IR(r=0.461,P<0.01),weight,BMI,FPG,Hb A1 c,TG(r=0.353,0.376,0.325,0.331,0.323,P<0.05).Multiple stepwise regression analysis showed that the decline of FGF-21 was mainly associated with the decrease of HOMA-IR(?=0.461,P<0.01).Conclusions1.The level of serum FGF-21 of obese patients with T2 DM is significantly higher than controls.Serum FGF-21 may associate with disorders of glucose and lipid metabolism and insulin resistance of obese patients with T2 DM.2.Exenatide can decrease the level of serum FGF-21,and may correlate with improved insulin resistance in obese patients with T2 DM.FGF-21 may participate in the mechanism of Exenatide in improving insulin resistance and reducing blood glucose and weight loss. |
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