Study On The Measurement Of T2DM Obesity In The Elderly,the Clinical Characteristics And Mechanism Of Metabolic Immunity

Objective: Elderly obesity(Eo)has become a risk factor for many diseases,and its mechanism may focus on its influence on metabolism and immunity.Taking T2 DM as the object,this paper explores the metabolic and immune characteristics of elderly obesity,confirms the harm of centripetal obesity,and explores a more accurate measurement method of elderly obesity,as well as the possible metabolic immune mechanism and action pathway of elderly obesity.Methods: Clinical data of hospital patients were collected to study the metabolic and immune characteristics of obesity and the measurement method of obesity,and a mouse model of elderly obesity with hyperglycemia was established to study the possible metabolic immune pathway of Ob.1.Collect clinical T2 DM,a total of 3260 cases of elderly patients and collect clinic during physical examination and biochemical indicators in detail,and according to the waist circumference(WC),body mass index(BMI),waist hip ratio(WHR),waist height ratio(WHt R)and Insulin Resistanse of Homeostasis model assessment(HOMA-IR)grouping,analysis the relationship between obesity indicators and metabolic and immune indexes.(1)metabolism study,according to BMI,WC,WHR and WHt R values Ob and the Ob group,group of metabolic indices between analysis including blood pressure,blood lipid(TC,TG,HDL-C,HDL-C),glucose(FPG,Hb A1c),urine trace albumin(ALBU),urine creatinine(Ucr),urine trace albumin/creatinine(UACR),diabetic kidney disease(DKD),diabetic neuropathy(DN),peripheral vascular disease(PVD),diabetic retinopathy(DR);(2)immune index analysis,according to the same value group,WC,BMI,and IR comparison group inflammation index between white blood cells(WBC),lymphocyte(L),Monocytes(M),neutrophils and monocytes(N),c-reactive protein(s CRP),and the immune indexes of C3(C3),C4,Ig M,Ig A,and Ig G differences between groups.(3)In the correlation study,the correlation between metabolic indexes and Ob indexes in three age groups of 60-69,70-79 and ≥80 years old was analyzed,and the most appropriate Ob measurement method for the elderly group was discussed.Statistical analysis was performed using Graph Pad Prism 8.0 and SPSS18.0 software.Statistical methods included independent sample t test,analysis of variance,chi-square test and Pearson or Spearman correlation analysis.0.05 was considered statistically significant.2.Elderly obesity model with hyperglycemia was established with C57BL/6J mice in animal experiments.The changes of metabolic characteristics in the process of modeling,fast blood glucoseof mice were tested during the feeding.The liver and mesenteric adipose tissue were collected and observed by HE staining cell morphology change,Western blot detection related protein expression.Results:1.Clinical patient research.1)WC group,centripetal obesity,Ao at a rate of44.95%,compared with the N-Ao,Hb A1 c,blood pressure,TC,TG,ALBU,Cr and metabolic diseases are on the rise,T2 DM complications is on the rise in male,female in DKD,DN is on the rise,PVD,DR a downward trend,of which the male patients with hypertension who are Ob(18.68% vs.43.39%),dyslipidemia(29.18% vs.80.95%),renal damage(11.28% vs.20.1%)and DR(21.4%vs.41.8%)were significantly increased,and there was statistically significant difference(P<0.05).2)In the BMI group,SBP,DBP,TC,TG,CR,ACR and the proportion of dyslipidemia all increased with the increase of BMI,while FPG,Hb A1 c,HDL,PVD and DR decreased with the increase of BMI.There were significant differences in SBP,DBP,HDL,TG and renal damage between Ob group and normal group(P<0.05).3)In the WHR group,there were differences in TC,HDL,TG and hyperlipidemia between the male AO group and the non-AO group(P<0.05),TG was the only difference among women(P<0.05),T2 DM complications and metabolic diseases showed a decreasing trend in males,but the opposite trend was observed in females.4)In the WHTR group,there were differences in SBP,DBP,TG and dyslipidemia between the two groups(P<0.05),T2 DM complications and metabolic diseases were not significantly different.5)In inflammatory markers,WBC was positively correlated with BMI(r=0.2,P<0.001),compared with the normal group,low body weight(F1 group)or overweight group and Ob(F3,F4 and F5group)all increased the absolute value of WBC,but L,N and NLR showed no statistically significant differences.6)In IR group,WBC(r=0.12,P=0.002),N(r=0.13,P<0.001),C3(r=0.3,P<0.001)and SCRP(r=0.1,P=0.007)were positively correlated with IR,while Ig M(r=-0.1,P=0.02)was negatively correlated with IR.7)With the increase of age,the correlation between measurement of body fat and metabolic indicators was no longer observed.2.In the animal experiment,all Ob models were successfully built in mice of the experimental group after 25 weeks of high-fat diet feeding,and mice were killed after continuing feeding to 13-15 months of age.(1)The glucose tolerance test showed that the blood glucose level of the Ob group at 0min,30 min,60min,90 min,120min and 180 min was significantly higher than that of the conventional feeding group(P<0.001),the area under the curve(AUC)was significantly increased(P<0.001).(2)He staining showed liver fat infiltration,abnormal enlargement of adipocytes in mesenteric adipose tissue and inflammatory infiltration in Ob group.(3)In Western-blot results,the expressions of MyD88,IL-1β and NLRP3 were up-regulated in Ob group,and the difference was statistically significant(P<0.05),while the expression of AMPK,ERK1/2 and p-Akt were up-regulated in the control group(P<0.05),p-AKT was significantly up-regulated(P<0.001).Conclusions:(1)In elderly T2 DM patients,obesity in women is higher than that in men.Abdominal obesity defined by WC has a higher incidence of T2 DM complications and metabolic diseases than systemic obesity defined by BMI.Abdominal obesity is more harmful than systemic obesity.(2)In elderly T2 DM patients,abdominal obesity indicators WC and WHTR can more accurately measure obesity than BMI.In elderly people,BMI cannot be used only to measure obesity,and the obesity paradox is not reliable.(3)With the increase of age,the error of BMI in measuring body fat increases.If BMI is used to measure obesity in the elderly,the cut-off point of adult measurement is no longer applicable.(4)The metabolic abnormalities in hyperglycemic elderly obese mice may be related to the impaired Akt signaling pathway,and AMPK is still the main energy regulation center.(5)In hyperglycemic elderly obese mice,both MyD88-dependent and independent pathways are involved in the regulation of immunity and inflammation,but the MyD88-dependent pathway is the dominant one.