Fernández-Real J M, Ricart-Engel W, Arroyo E, Balançá R, Casamitjana-Abella R, Cabrero D, Fernández-Castañer M, Soler J
Section of Endocrinology, Hospital de Girona, Spain.
Diabetes Care. 1998 Jan;21(1):62-8. doi: 10.2337/diacare.21.1.62.
In epidemiological studies, serum ferritin was the second-strongest determinant of blood glucose (after BMI) in regression models and the third-strongest determinant of serum insulin (after BMI and age). Its concentration also correlated positively with plasma triglycerides and apolipoprotein B concentrations, and negatively with HDL2 cholesterol. We hypothesized that serum ferritin could be a marker of insulin resistance.
Oral glucose tolerance and insulin sensitivity (SI, minimal model method) were prospectively evaluated in 36 healthy subjects. The relationship between serum ferritin and metabolic control (as measured by HbA1c levels) was also studied in 76 consecutive NIDDM patients.
In healthy subjects, log-transformed serum ferritin (LOGFER) correlated with basal serum glucose (r = 0.44, P = 0.007), but not with BMI, age, systolic or diastolic blood pressure, total cholesterol, VLDL cholesterol, HDL cholesterol, total triglycerides, VLDL triglycerides, serum insulin, or HbA1c (all P = NS). Identical results were obtained when the two lowest quartiles of serum ferritin were evaluated separately. However, in the two highest quartiles, LOGFER correlated with BMI (0.50, P = 0.02), diastolic blood pressure (r = 0.8, P < 0.0001), serum LDL cholesterol (r = 0.57, P = 0.01), VLDL cholesterol (r = 0.48, P = 0.03), total cholesterol and HDL2 and HDL3 subtractions of HDL cholesterol (r = -0.68, -0.76, -0.55, P = 0.001. < 0.0001, and 0.01, respectively), total triglycerides (r = 0.60, P = 0.006), HDL2/HDL3 quotient (P = -0.71, P = 0.001), VLDL triglycerides (r = 0.65, P = 0.004), and serum uric acid (r = 0.51, P = 0.03), but not with systolic blood pressure (r = 0.38, P = 0.15). After adjusting for BMI, only the correlations between LOGFER and diastolic blood pressure (r = 0.7, P = 0.002) and HDL2/HDL3 quotient (r = -0.63, P = 0.01) remained significant. Strong correlations between LOGFER and glucose area under the curve during oral glucose tolerance test (Pearson's r = 0.73, P = 0.001) and SI (r = -0.68, P = 0.001), which remained significant after controlling for BMI, were observed. LOGFER (beta = -0.44, P = 0.01) and BMI (beta = -0.52, P = 0.004) constituted independent predictors of insulin sensitivity in a multivariate analysis (R2 = 0.68). In 76 consecutive NIDDM outpatients, serum glucose (P < 0.00001) and LOGFER (P = 0.03) independently predicted the value of HbA1c (R2 = 0.40) in a multiple linear regression analysis.
The correlations among serum ferritin and diastolic blood pressure, HDL quotient, glucose area under the curve, and SI suggest that serum ferritin could be a marker of the insulin resistance syndrome. Serum ferritin may also be an independent determinant of poor metabolic control in the diabetic patient.
在流行病学研究中，血清铁蛋白在回归模型中是血糖的第二强决定因素（仅次于体重指数），是血清胰岛素的第三强决定因素（仅次于体重指数和年龄）。其浓度还与血浆甘油三酯和载脂蛋白B浓度呈正相关，与高密度脂蛋白2胆固醇呈负相关。我们推测血清铁蛋白可能是胰岛素抵抗的一个标志物。
对36名健康受试者进行了口服葡萄糖耐量和胰岛素敏感性（SI，最小模型法）的前瞻性评估。还对76例连续的非胰岛素依赖型糖尿病（NIDDM）患者研究了血清铁蛋白与代谢控制（通过糖化血红蛋白水平衡量）之间的关系。
在健康受试者中，经对数转换的血清铁蛋白（LOGFER）与基础血清葡萄糖相关（r = 0.44，P = 0.007），但与体重指数、年龄、收缩压或舒张压、总胆固醇、极低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、总甘油三酯、极低密度脂蛋白甘油三酯、血清胰岛素或糖化血红蛋白均无关（所有P =无统计学意义）。当分别评估血清铁蛋白的两个最低四分位数时，得到了相同的结果。然而，在两个最高四分位数中，LOGFER与体重指数（r = 0.50，P = 0.02）、舒张压（r = 0.8，P < 0.0001）、血清低密度脂蛋白胆固醇（r = 0.57，P = 0.01）、极低密度脂蛋白胆固醇（r = 0.48，P = 0.03）、总胆固醇以及高密度脂蛋白胆固醇的高密度脂蛋白2和高密度脂蛋白3差值（r = -0.68，-0.76，-0.55，P分别为0.001、< 0.0001和0.01）、总甘油三酯（r = 0.60，P = 0.006）、高密度脂蛋白2/高密度脂蛋白3商数（r = -0.71，P = 0.001）、极低密度脂蛋白甘油三酯（r = 0.65，P = 0.004）和血清尿酸（r = 0.51，P = 0.03）相关，但与收缩压无关（r = 0.38，P = 0.15）。在调整体重指数后，仅LOGFER与舒张压（r = 0.7，P = 0.002）和高密度脂蛋白2/高密度脂蛋白3商数（r = -0.63，P = 0.01）之间的相关性仍然显著。观察到LOGFER与口服葡萄糖耐量试验期间曲线下葡萄糖面积（Pearson相关系数r = 0.73，P = 0.001）和SI（r = -0.68，P = 0.001）之间有很强的相关性，在控制体重指数后这些相关性仍然显著。在多变量分析中，LOGFER（β = -0.44，P = 0.01）和体重指数（β = -0.憨豆先生52，P = 0.004）构成了胰岛素敏感性的独立预测因素（R2 =憨豆先生68）。在76例连续的NIDDM门诊患者中，在多元线性回归分析中，血清葡萄糖（P < 0.00001）和LOGFER（P = 0.03）独立预测糖化血红蛋白的值（R2 = 0.40）。
血清铁蛋白与舒张压、高密度脂蛋白商数、曲线下葡萄糖面积和SI之间的相关性表明，血清铁蛋白可能是胰岛素抵抗综合征的一个标志物。血清铁蛋白也可能是糖尿病患者代谢控制不良的一个独立决定因素。
