Professor of Medicine, ABVIMS and Dr. RML Hospital, New Delhi.
PG Resident of Medicine, ABVIMS and Dr. RML Hospital, New Delhi.
J Assoc Physicians India. 2021 Jul;69(7):11-12.
Atherosclerotic cardiovascular diseases are the leading cause of morbidity and mortality in both diabetics and prediabetics. In insulin resistant states, increased levels of various adipose derived cytokine (adipokine) have been found to have an important role in the process of atherosclerosis. One such novel adipokine is RBP4, (belonging to lipokalin family) which also by exerting an inflammatory process has a role in the pathogenesis of insulin resistance and CVD.. Early detection of all these inflammatory cytokines may immensely help us in prognosticating the pace of disease besides instituting early interventional manuevers.
The aim of the study was to compare serum levels of RBP4 in prediabetics and controls and to correlate levels of RBP4 with HOMA-IR and CIMT.
60 prediabetic patients and 60 age, sex, BMI matched controls were employed in the case control study. In both cases and controls serum levels of fasting and postprandial blood glucose, glycated hemoglobin (HbA1c) and fasting insulin levels were measured. HOMA-IR values in both the groups were calculated using fasting glucose and insulin levels. Serum RBP4 levels were measured using ELISA. The values obtained were compared between cases and controls. CIMT was only measured in cases using B-mode ultrasonography.
Median (IQR) of fasting plasma insulin levels (uIU/ml)in cases was 11.3 (10.175-13.505) versus that of controls which was 5.73 (4.3-7.1). HOMA-IR median (IQR) in cases and controls was 3.12 (2.73-3.595) and 1.21(0.918-1.505) respectively. Median (IQR) for RBP4 in cases was 67.4 (46.166-111.088) which was significantly higher as compared to controls 33.92 (23.902-52.45). Significant positive correlation was seen between RBP4 with both, HOMA-IR and mean CIMT with correlation coefficients of 0.3693 and 0.621 respectively. On performing univariate linear regression analysis it was found that with increase in serum RBP4 levels by 1 mg/L, HOMA-IR and mean CIMT significantly increased by 0.007 units and 0.001 mm respectively.
60 prediabetic patients and 60 age, sex, BMI matched controls were employed in the case control study. In both cases and controls serum levels of fasting and postprandial blood glucose, glycated hemoglobin (HbA1c) and fasting insulin levels were measured. HOMA-IR values in both the groups were calculated using fasting glucose and insulin levels. Serum RBP4 levels were measured using ELISA. The values obtained were compared between cases and controls. CIMT was only measured in cases using B-mode ultrasonography.
Prediabetics have been found to have more risk of cardiovascular events as compared to normoglycemics. Early assessment of the same with the use of novel biomarkers like RBP4 can be considered for early detection of atherosclerosis in prediabetic individuals. It may further help in early intervention and thus prevention from future complications.
动脉粥样硬化性心血管疾病是糖尿病患者和糖尿病前期患者发病和死亡的主要原因。在胰岛素抵抗状态下，发现各种脂肪来源的细胞因子（ adipokine ）水平升高在动脉粥样硬化的发生过程中具有重要作用。一种新的 adipokine 是 RBP4（属于 lipokalin 家族），它通过发挥炎症过程在胰岛素抵抗和 CVD 的发病机制中也具有作用。早期检测所有这些炎症细胞因子可能会极大地帮助我们预测疾病的进展速度，同时还可以进行早期干预。
本研究旨在比较糖尿病前期患者和对照组的血清 RBP4 水平，并将 RBP4 水平与 HOMA-IR 和 CIMT 相关联。
在病例对照研究中，纳入了 60 例糖尿病前期患者和 60 例年龄、性别、BMI 匹配的对照组。在病例和对照组中均测量空腹和餐后血糖、糖化血红蛋白（HbA1c）和空腹胰岛素水平。使用空腹血糖和胰岛素水平计算两组的 HOMA-IR 值。使用 ELISA 测量血清 RBP4 水平。比较病例和对照组之间的测量值。仅对病例使用 B 型超声测量 CIMT。
病例组空腹血浆胰岛素水平（uIU/ml）中位数（IQR）为 11.3（10.175-13.505），而对照组为 5.73（4.3-7.1）。病例组和对照组的 HOMA-IR 中位数（IQR）分别为 3.12（2.73-3.595）和 1.21（0.918-1.505）。病例组 RBP4 的中位数（IQR）为 67.4（46.166-111.088），明显高于对照组的 33.92（23.902-52.45）。RBP4 与 HOMA-IR 和平均 CIMT 均呈显著正相关，相关系数分别为 0.3693 和 0.621。进行单变量线性回归分析后发现，血清 RBP4 水平每增加 1mg/L，HOMA-IR 和平均 CIMT 分别显著增加 0.007 单位和 0.001mm。
在病例对照研究中，纳入了 60 例糖尿病前期患者和 60 例年龄、性别、BMI 匹配的对照组。在病例和对照组中均测量空腹和餐后血糖、糖化血红蛋白（HbA1c）和空腹胰岛素水平。使用空腹血糖和胰岛素水平计算两组的 HOMA-IR 值。使用 ELISA 测量血清 RBP4 水平。比较病例和对照组之间的测量值。仅对病例使用 B 型超声测量 CIMT。
与血糖正常者相比，糖尿病前期患者发生心血管事件的风险更高。使用新型生物标志物（如 RBP4）早期评估这一点可以考虑用于早期检测糖尿病前期个体的动脉粥样硬化。它还可以进一步帮助早期干预，从而预防未来的并发症。
