老年糖尿病性白内障患者血清Spexin和Pannexin1表达水平及临床意义

doi:10.11958/20240821

摘要/Abstract

摘要：

目的研究老年糖尿病性白内障患者血清Spexin、缝隙连接蛋白1（Pannexin1）表达水平与糖脂代谢和胰岛素抵抗水平的相关性。方法选取118例老年糖尿病性白内障患者，对照组为同期在本院进行治疗的103例老年糖尿病非白内障患者。采用酶联免疫吸附试验（ELISA）检测各组血清Spexin、Pannexin1水平；检测糖代谢相关指标：空腹血糖（FPG）和糖化血红蛋白（HbA1c）；脂代谢相关指标：三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-C）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）；胰岛素抵抗相关指标：空腹胰岛素（FINS），计算胰岛素敏感性指数（ISI）、胰岛素抵抗指数（HOMA-IR）、胰岛β细胞功能指数（HOMA-β）；采用Pearson法对血清Spexin、Pannexin1水平与糖脂代谢以及胰岛素抵抗指标进行相关性分析；受试者工作特征（ROC）曲线评估血清Spexin、Pannexin1水平以及二者联合对老年糖尿病患者发生白内障的预测价值。结果观察组Spexin水平较对照组降低，Pannexin1水平较对照组升高（P<0.01）。观察组TG、TC、LDL-C、FPG、HbA1c、FINS、HOMA-IR较对照组升高，HDL-C、ISI、HOMA-β水平较对照组降低（P<0.01）。Pearson相关性分析结果显示，老年糖尿病性白内障患者血清Spexin水平与ISI、HOMA-β呈正相关，与TG、TC、LDL-C、FPG、HbA1c、FINS、HOMA-IR呈负相关（P<0.05）；血清Pannexin1与ISI、HOMA-β呈负相关，与TG、TC、LDL-C、FPG、HbA1c、FINS、HOMA-IR呈正相关（P<0.05）；均与HDL-C不具有相关性（P>0.05）。血清Spexin、Pannexin1二者联合预测老年糖尿病患者发生白内障优于血清Spexin和Pannexin1单独评估（Z_{二者联合-Spexin}=3.220、Z_{二者联-Pannexin1}=4.838，均P<0.001）。结论老年糖尿病性白内障患者血清Spexin表达降低、Pannexin1表达升高，且与糖脂代谢和胰岛素抵抗存在一定的相关性。

关键词: 糖尿病, 白内障, 胰岛素抵抗, Spexin, 缝隙连接蛋白1, 糖脂代谢, 老年人

Abstract:

Objective To study the correlation between expression levels of serum Spexin and Pannexin 1 protein, glucose and lipid metabolism and insulin resistance in elderly patients with diabetic cataract.Methods A total of 118 elderly diabetic cataract patients were selected as the case group, and 103 elderly diabetic non-cataract patients were selected as the control group who were treated in the same hospital during the same period. Serum levels of Spexin and Pannexin1 were detected by enzyme-linked immunosorbent assay (ELISA). Fasting blood glucose (FPG) and glycosylated hemoglobin (HbA1c) were measured. Lipid metabolism related indicators including triacylglycerol (TG), high density lipoprotein cholesterol (HDL-C), total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C) were detected in two groups of patients. Insulin resistance related indexes: fasting insulin (FINS), insulin sensitivity index (ISI), insulin resistance index (HOMA-IR) and islet beta cell function index (HOMA-β) were also detected. The correlation between serum Spexin and Pannexin1 levels, glucolipid metabolism and ISI was detected by Pearson method. Receiver operating characteristic (ROC) curves were used to assess the predictive value of serum Spexin and Pannexin1 levels and their combination in the development of cataract in elderly diabetic patients.Results The level of Spexin was lower in the observation group than that in the control group, and the level of Pannexin1 was higher than that in the control group (P<0.01). Levels of TG, TC, LDL-C, FPG, HbA1c, FINS and HOMA-IR of the observation group increased compared with the control group, while HDL-C, ISI and HOMA-β levels decreased compared with the control group (P<0.01). Pearson correlation analysis showed that serum Spexin level was positively correlated with ISI and HOMA-β, and negatively correlated with TG, TC, LDL-C, FPG, HbA1c, FINS and HOMA-IR in elderly patients with diabetic cataract (P<0.05). Serum Pannexin1 was negatively correlated with ISI and HOMA-β, and positively correlated with TG, TC, LDL-C, FPG, HbA1c, FINS and HOMA-IR (P<0.05). There was no correlation between the above indexes and HDL-C (P>0.05). The combination of both serum Spexin and Pannexin1 predicted the development of cataracts in elderly diabetic patients was better than serum Spexin and Pannexin1 assessed individually (Z _{both combination-Spexin}=3.220, P=0.001, Z _{both combination-Pannexin1}=4.838, P<0.001).Conclusion In elderly patients with diabetic cataract, the expression of serum Spexin decreases and the expression of Pannexin1 increases, and they have a certain correlation with glucose and lipid metabolism and insulin resistance

Key words: diabetes mellitus, cataract, insulin resistance, Spexin, Pannexin 1, glycolipid metabolism, aged

中图分类号:

R776.1

图/表 8

参考文献 24

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组别		n	性别（男/女）		年龄/岁		饮酒（是/否）		吸烟（是/否）		眼底盘周厚度/μm
对照组		103	46/57		70.03±8.26		52/51		58/45		91.23±9.33
观察组		118	66/52		69.82±8.17		61/57		72/46		93.51±9.45
χ²或t			2.796		0.187		0.032		0.503		1.791
组别	糖尿病病程/年			眼压/mmHg		体质量指数/（kg/m²）		收缩压/mmHg		舒张压/mmHg		视力/D
对照组	3.16±0.61			15.39±2.03		24.59±3.46		123.92±15.14		80.75±9.17		0.73±0.09
观察组	3.28±0.57			15.62±2.17		24.13±3.43		126.37±15.76		81.06±9.64		0.71±0.07
t	1.572			0.811		0.991		1.175		0.245		1.941

组别		n	性别（男/女）		年龄/岁		饮酒（是/否）		吸烟（是/否）		眼底盘周厚度/μm
对照组		103	46/57		70.03±8.26		52/51		58/45		91.23±9.33
观察组		118	66/52		69.82±8.17		61/57		72/46		93.51±9.45
χ²或t			2.796		0.187		0.032		0.503		1.791
组别	糖尿病病程/年			眼压/mmHg		体质量指数/（kg/m²）		收缩压/mmHg		舒张压/mmHg		视力/D
对照组	3.16±0.61			15.39±2.03		24.59±3.46		123.92±15.14		80.75±9.17		0.73±0.09
观察组	3.28±0.57			15.62±2.17		24.13±3.43		126.37±15.76		81.06±9.64		0.71±0.07
t	1.572			0.811		0.991		1.175		0.245		1.941

组别	n	Spexin	Pannexin1
对照组	103	2.61±0.42	6.27±1.36
观察组	118	2.17±0.34	8.12±2.04
t		8.601^＊＊	7.811^＊＊

组别	n	Spexin	Pannexin1
对照组	103	2.61±0.42	6.27±1.36
观察组	118	2.17±0.34	8.12±2.04
t		8.601^＊＊	7.811^＊＊

组别		n	TG/（mmol/L）		HDL-C/（mmol/L）		TC/（mmol/L）
对照组		103	1.28±0.27		1.96±0.29		3.19±0.41
观察组		118	3.36±0.41		1.58±0.23		5.28±0.62
t			44.425^＊＊		10.777^＊＊		30.025^＊＊
组别	LDL-C/（mmol/L）			FPG/（mmol/L）		HbA1c/%		FINS/（mU/L）
对照组	2.17±0.24			5.61±0.69		4.26±0.57		13.86±1.57
观察组	2.65±0.29			10.22±1.64		5.53±0.66		19.05±2.16
t	13.731^＊＊			27.865^＊＊		15.231^＊＊		20.639^＊＊