| Research BackgroundWith the improvement of social urbanization level,the rapid transformation of lifestyle has resulted in increasing risk factors which associated with chronic non-communicable diseases such as type 2 diabetes,obesity and hyperuricemia.At present,the incidence of type 2 diabetes in China has jumped tol0.9%in the world,and the prevalence rate of pre diabetes is 35.7%.Therefore,it has become an important point to explore the process of diabetic pathophysiology to find effective prevention and control programs.Cytokines play a positive or negative role in glycolipid metabolism and energy balance by acting on different targets and signaling pathways.Among them,the anti-inflammatory cytokines are mainly secreted by normal tissues or cells,participate in the energy metabolism of tissues or reduce the inflammatory reaction of the body,so they may become biomarkers and new targets for treatment of obesity,insulin resistance and type 2 diabetes.As a newly discovered cytokines recently,Spexin is a highly conserved polypeptide and highly expressed in the endocrine system and the studies have shown that Spexin is related to endocrine metabolism and cell proliferation and differentiation.A recent study found that Spexin gene expression mediated by insulin receptor,and have related to MAPK and PI3K/Akt insulin signaling pathway,suggesting that it may play an important role in regulating insulin sensitivity,but the specific mechanism has not yet further study.The research of Spexin in patients with type 2 diabetes and obesity is limited.,there are still many differences and the relationship between type 2 diabetes and obesity,and regulating factors and research levels of galanin related to diabetes is still in the blank.The study will provide more clinical evidence for elucidating the pathophysiology of Spexin in type 2 diabetes by analyzing the correlation between serum Spexin and glycolipid metabolism,insulin resistance and other metabolic parameters.ObjectivesTo observe the expression of serum spexin in the newly diagnosed type 2 diabetic patients and the control group.On further assessment of the subgroup analysis of differential expression of serum spexin for the patients with different BMI in type 2 diabetes,and to analyze the level of serum spexin and glucose metabolism,lipid metabolism,insulin resistance and the correlation of endogenous galanin concentration,to explore the effect of spexin in type 2 diabetes and obesity.MethodsIn this study,193 cases were included in Zhujiang Hospital of Southern Medical University.According to the diagnostic criteria of diabetes mellitus reported by WHO diabetes expert committee in 1999,100 cases of newly diagnosed type 2 diabetes mellitus were included,including 54 males and 46 females,aged 20-70 years.At the same time,according to the matching of age and sex ratio,93 healthy subjects were selected as normal control group,which including 49 male and 44 female.According to the standardized personal information questionnaire,we collected and registered all the participants’ basic information,medical history,family history and medication history,and did physical examination.In addition,by professionals to take antecubital venous blood samples of 2 blood samples,a by enzyme-linked immunosorbent assay(ELISA)for serum Spexin and galanin(galanin)level of detection,the other blood samples for routine biochemical tests,including fasting blood glucose(FPG),fasting insulin(FIns),fasting C peptide,glycosylated hemoglobin(HbAlc),high sensitive C reactive protein(hs-CRP),total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),uric acid(UA),alanine aminotransferase(ALT),aspartic acid aminotransferase(AST)and other biochemical indicators.According to the formula,insulin resistance index(HOMA-IR),insulin secretion index(HOMA-%beta)and insulin sensitivity index(QUICKI)were calculated to evaluate insulin resistance,pancreatic beta cell secretion function and insulin sensitivity.The experimental data were collected,and data were analyzed by SPSS 20 software.The difference between two groups of laboratory indicators was compared,and the mechanism and diagnostic effect of the new fat factor Spexin in newly diagnosed type 2 diabetes were analyzed.Results1.Compared with the normal control group,the serum Spexin concentration in the newly diagnosed type 2 diabetes group was significantly lower,and the difference was statistically significant([200.96(89.22-53.48)pg/mlvs.478.9(175.27-848.47)pg/ml,P<0.01].2.Serum Spexin expression in different subgroups:In type 2 diabetes and normal control group,the serum Spexin concentration in overweight/obese patients was significantly lower than those in normal weight group,and the difference was more significant in type 2 diabetes group(P<0.01).Compared with the non-insulin resistance group,the serum Spexin concentration in the insulin resistance group was significantly decreased,and the serum Spexin concentration in the insulin resistance group was only 0.20 times higher than that in the non insulin resistance group,[106.28(49.04-148.88)pg/ml vs.663.94(208.12-875.52)pg/ml,P<0.01].The level of serum Spexin was different between different sexes(P<0.05).3.The correlation between serum Spexin level and clinical indicators:correlation analysis showed that serum Spexin concentration was positively correlated with QUICKI index,HOMA-%β,HDL-C,GAL and negatively correlated with BMI,waist circumference,WHR,FPQ Fins,fasting C peptide,HbAlc,HOMA-IR(<0.05).Multiple stepwise regression analysis showed that sex,waist circumference,WHR,fasting C peptide,HOMA-%β and TG were independent factors affecting serum Spexin(P<0.05).4.Diagnostic significance of serum Spexin level on disease:The cut-off value of Spexin concentration in predicting the occurrence of type 2 diabetes is 321.72pg/ml,the area under the curve(AUC)was 0.641(95%CI 0.56-0.72,P<0.01),the sensitivity is 66.2%and the specificity was 64.4%.The cut-off value of serum Spexin in predicting the occurrence of non overweight/obesity is 523.4pg/ml,AUC is 0.662(95%CI 0.581-0.737,P<0.001),the sensitivity is 81.8%and the specificity is 47.4.0%.Conclusions1.Compared with the control group,serum Spexin concentrations in type 2 diabetes and overweight/obese patients were significantly reduced and which were closely related to glucose and lipid metabolism and insulin resistance.In addition,we found that the concentration of Spexin is associated with f the biologically active peptide galanin.2.Low concentrations of Spexin is a risk factors for type 2 diabetes and overweight/obesity.Spexin may be involved in the development of type 2 diabetes and obesity or as the essential clinical indicator of the status of type 2 diabetes.3.Serum Spexin may be a new cytokine related to cardiovascular disease.Low concentration of Spexin may be a risk factor for cardiovascular events. |
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