Correlation Between Insulin Resistance With Renin-angiotensin-aldosterone System And Monocyte Chemoattractant Protein-1 In Patients With Various Glucose Tolerance Levels

ObjectiveThe incidence of type 2 diabetes has exploded worldwide.This "epidemic" is largely accompanied by the prevalence of obesity,Accompanied by rapid changes in Western lifestyle patterns on a global scale,this epidemic has occurred not only in rich countries but also in industrialized countries.Insulin resistance is a known risk factor for type 2 diabetes and is a major cause of morbidity and mortality worldwide.Several studies have found that inhibition of RAAS may play a key role in the protection of islet cell function and may also prevent the development of T2 DM.Monocyte chemoattractant protein-1 promotes the accumulation of tissue macrophages and the inflammatory state of insulin resistance by inducing inflammatory cytokines.Studies at home and abroad have shown that RAAS and monocyte chemotactic factor-1 are all factors that influence insulin resistance and are the causative agents of diabetes.In this study,the fasting blood glucose and fasting insulin levels in patients with different glucose tolerance levels were analyzed to calculate the homeostasis model assessment of insulin resistance index(HOMA-IR),and the activity of RAAS in blood and the expression level of MCP-1 were measured to evaluate different sugars.The relationship between insulin resistance and RAAS and MCP-1 in patients with tolerance level,and explore the possible pathogenesis of RAAS and MCP-1 in diabetic insulin resistance,and provide a new direction for the clinical treatment of diabetes.MethodsFrom October 2016 to August 2017,a total of 128 patients were hospitalized at the First Hospital of Shanxi Medical University.There was no statistical difference in the base data of the three groups of subjects in terms of gender,age,body mass index,and blood pressure.According to the WHO 1999 diagnostic criteria for type 2 diabetes,they were divided into normal glucose tolerance(NGT)group,impaired glucose regulation(IGR)group and new-onset diabetes(T2DM)group.In the present study,type 2 diabetes mellitus was a primary diabetic patient.No dietary control and any drug intervention were performed.The NGT group was an outpatient health checker or volunteer.Among them,43 patients were normal glucose tolerance(22 males and 21 females),41 patients with impaired glucose regulation(21 males and 20 females)and 44 patients with type 2 diabetes(24 males and 20 females).All subjects were measured for biochemical parameters such as renin,angiotensin II,aldosterone,monocyte chemoattractant factor-1(MCP-1),fasting plasma glucose,postARRndial 2h blood glucose,and HbA1 c to calculate HOMA-IR,HOMA-?,ARR,and related statistical analysis of these biochemical indicators.Results1.There were no statistically significant differences in the general information of the three groups,such as age,sex,BMI,serum potassium and lipids(TG?TC?HDL-C?LDL-C),SBP and DBP.2.The difference between the MCP-1 and HOMA-? in the type 2 diabetes group and the impaired glucose regulation group was statistically significant compared with the normal group,and the fasting insulin level in the type 2 diabetes group was comparable to that in the IGR group and NGT group.The difference was statistically significant.3.The three groups of HOMA-IR,HbA1 c,fasting blood glucose,postARRndial 2h blood glucose,and angiotensin II had statistically significant differences in the comparison between the two groups;the three groups had no significant difference in renin,aldosterone,and ARR.4.Pearson correlation analysis showed that: the HOMA IR and MCP-1(r=0.266,p=0.002),angiotensin ?(r=0.27,p=0.002)were positively correlated,renin ?aldosterone and ARR no correlation.Conclusion1.With the increase of blood glucose levels,the more obvious the insulin resistance,the more severe islet ?-cell function is damaged;the activity of MCP-1 and angiotensin? in circulating blood is also higher and higher,and MCP-1 and angiotensin ? can be used as One of the early indicators of diabetes2.Angiotensin ? is also associated with MCP-1,angiotensin ? and MCP-1 are involved in the development of diabetes.3.There was no statistically significant difference between the three groups of renin?aldosterone and ARR,and there was no correlation with insulin resistance,so the three were not involved in the development of insulin resistance.