性激素结合球蛋白是新诊断2型糖尿病男性患者胰岛素抵抗的独立预测指标。
Sex Hormone Binding Globulin is an Independent Predictor for Insulin Resistance in Male Patients with Newly Diagnosed Type 2 Diabetes Mellitus.
作者信息
Huang Rong, Wang Ying, Yan Rengna, Ding Bo, Ma Jianhua
机构信息
Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, No.32 Gongqingtuan Road, Nanjing, 210012, China.
出版信息
Diabetes Ther. 2023 Oct;14(10):1627-1637. doi: 10.1007/s13300-023-01445-x. Epub 2023 Jul 18.
INTRODUCTION
This study explored the correlation between sex hormones, sex hormone binding globulin (SHBG), and insulin resistance in male patients with newly diagnosed type 2 diabetes mellitus (T2DM).
METHODS
A total of 48 male patients with newly diagnosed T2DM were enrolled in this study between March 2022 and December 2022. Clinical characteristics, sex hormones, and SHBG levels were collected. All enrolled subjects received intensive hypoglycemic treatment with insulin pump for 1 week to achieve glycemic control, then the steady-state glucose infusion rate (GIR), an indicator of insulin sensitivity, was determined by the hyperinsulinemic-euglycemic clamp. Correlation analysis and multivariate logistic regression analysis were performed to explore the association of clinical characteristics, sex hormones, and SHBG with insulin sensitivity. The optimal cutoff value to predict insulin resistance was calculated using receiver operating characteristic (ROC) curve.
RESULTS
According to the GIR cut-point value of 5.700 mg/(kg min), there were 40 patients with insulin resistance (IR group) and 8 patients without (non-IR group). The IR group exhibited lower testosterone and SHBG levels than the non-IR group (all p < 0.050). Correlation analysis showed that insulin sensitivity was positively associated with testosterone and SHBG, while negatively associated with body mass index, fasting blood glucose, alanine aminotransferase, aspartate aminotransferase, total cholesterol, triglyceride, and apolipoprotein B (all p < 0.050). Multivariate logistic regression analysis demonstrated that SHBG is an independent predictor for insulin resistance (p = 0.029). Further ROC curve analysis revealed that the optimal cutoff value of SHBG to predict insulin resistance is 17.200 nmol/L, with the corresponding area under the curve (AUC) and its 95% confidence interval (CI) being 0.813 and 0.691-0.934.
CONCLUSIONS
SHBG is an independent predictor for insulin resistance in male patients with newly diagnosed T2DM.
TRIAL REGISTRATION NUMBER
KY20220314-01.
引言
本研究探讨了新诊断的2型糖尿病（T2DM）男性患者性激素、性激素结合球蛋白（SHBG）与胰岛素抵抗之间的相关性。
方法
2022年3月至2022年12月，本研究共纳入48例新诊断的T2DM男性患者。收集临床特征、性激素和SHBG水平。所有入选受试者接受胰岛素泵强化降糖治疗1周以实现血糖控制，然后通过高胰岛素-正常血糖钳夹法测定稳态葡萄糖输注率（GIR），这是胰岛素敏感性的一个指标。进行相关性分析和多因素逻辑回归分析，以探讨临床特征、性激素和SHBG与胰岛素敏感性之间的关联。使用受试者工作特征（ROC）曲线计算预测胰岛素抵抗的最佳截断值。
结果
根据GIR切点值5.700 mg/（kg·min），有40例胰岛素抵抗患者（IR组）和8例无胰岛素抵抗患者（非IR组）。IR组的睾酮和SHBG水平低于非IR组（所有p < 0.050）。相关性分析表明，胰岛素敏感性与睾酮和SHBG呈正相关，而与体重指数、空腹血糖、丙氨酸转氨酶、天冬氨酸转氨酶、总胆固醇、甘油三酯和载脂蛋白B呈负相关（所有p < 0.050）。多因素逻辑回归分析表明，SHBG是胰岛素抵抗的独立预测因子（p = 0.029）。进一步的ROC曲线分析显示，预测胰岛素抵抗的SHBG最佳截断值为17.200 nmol/L，相应的曲线下面积（AUC）及其95%置信区间（CI）为0.813和0.691 - 0.934。
结论
SHBG是新诊断的T2DM男性患者胰岛素抵抗的独立预测因子。
试验注册号
KY20220314 - 01。
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