【摘要】  目的    探讨T2DM合并抑郁患者炎性因子和胰岛素抵抗指数(HOMA-IR)的变化。 方法  选择单纯抑郁组44例，单纯T2DM组(T2DM) 124例，T2DM合并抑郁组(T2DM+抑郁) 48例，另选正常体检人群（NC）40名，分别测定各组汉密尔顿抑郁量表（HAMD）评分、FPG、HbA1c、FIns、FC-P、高敏C反应蛋白（hsC-RP）、白介素-2(IL-2)、IL-10、胰岛素样生长因子-1（IGF-1）等指标。 结果   与NC、单纯抑郁组及T2DM组相比，T2DM+抑郁组FPG[（5.11±0.25），（5.18±0.22）（9.47±

3.46）vs（11.51±2.05）mmol/L]、HbA1c[(5.53±0.32）%，（5.36±0.34）%，（8.89±2.21）% vs（10.28±2.12）%、hsC-RP[（1.10±0.36），（4.02±1.96），（3.54±2.05）vs（9.20±2.11）mg/L] 、IL-2[（122.00±4.01），（144.10±

9.90），（142.64±15.36）vs（166.86±22.81）pg/ml]、HOMA-IR[（1.14±0.24），（1.58±0.21），（2.70±1.54）vs（3.78±1.08）升高；IL-10[2.10(1.99,3.84) vs 4.72（3.94,5.98），3.44（3.13,4.35），4.00（3.39,4.11）pg/ml]、胰岛素敏感指数（ISI）[（-4.41±0.27）vs（-3.22±0.22），（-3.57±0.13），（-3.92±0.60）]、IGF-1[（80.15±39.26）vs （224.33±20.74），（166.20±32.79），（169.18±46.14）pg/ml]降低（P＜0.05）。相关分析显示，HAMD评分与hsC-RP、IL-2呈正相关，与IL-10、IGF-1呈负相关；多元逐步回归分析显示，hsC-RP、IGF-1是HAMD评分的影响因素；Logistic回归分析表明，hsC-RP是T2DM并发抑郁的危险因素。  结论   T2DM合并抑郁患者炎性反应及IR更严重，hsC-RP与T2DM患者发生抑郁相关。
    【关键词】  糖尿病，2型；抑郁状态；高敏C反应蛋白；白介素-2；白介素-10；胰岛素抵抗；胰岛素样生长因子-1

   Clinical value of inflammatory factors and insulin resistance index in T2DM patients with depression

    【Abstract】 Objective  To investigate the changes of inflammatory factors and insulin resistance index in T2DM patients with depression.  Methods   All the subjects were divided into four groups: depression without T2DM group (Depression group, n=44)，T2DM without depression group (T2DM group, n=124) , T2DM with depression group (DM-depression group, n=48), and healthy people selected from medical examination center as the normal control (NC group, n=40). The levels of FPG, HbA1c, FIns, FC-P, hypersensitive C-reactive protein (hsC-RP), Interleukin-2 (IL-2), Interleukin-10 (IL-10), and Insulin-like growth factor-1(IGF-1) were measured.  Results  FPG[（5.11±0.25），（5.18±0.22），（9.47±3.46） vs（11.51±2.05）mmol/L], HbA1c[(5.53±0.32)%，（5.36±0.34）%，（8.89±2.21）% vs（10.28±2.12）%], hsC-RP[（1.10±0.36），（4.02±1.96），（3.54±2.05）vs（9.20±2.11）mg/L], IL-2[（122.00±4.01），（144.10±9.90），（142.64±15.36）vs（166.86±22.81）pg/ml]

and HOMA-IR[（1.14±0.24），（1.58±0.21），（2.70±1.54）vs（3.78±1.08ere all increased in DM-depres-

sion group than in NC, Depression group and T2DM group. However, IL-10[2.10(1.99,3.84) vs 4.72（3.94,5.98），3.44（3.13,4.35），4.00（3.39,4.11）pg/ml], insulin sensitive index（ISI）[（-4.41±0.27）vs （-3.22±0.22），（-3.57±0.13），（-3.92±0.60）] and IGF-1[（80.15±39.26）vs  （224.33±20.74），（166.20±32.79），（169.18±46.14）pg/ml] were all decreased in in DM-depression group than in NC, Depression group and T2DM group. Association analysis found that the Hamilton Depression Scale (HAMD) score was positively correlated with hsC-RP and IL-2 but negatively correlated with IL-10 and IGF-1. The multiple stepwise regression analysis showed that hsC-RP and IGF-1 were influencing factors for HAMD score. Logistic regression analysis showed that hsC-RP was a risk factor for T2DM patients with depression.   Conclusion   Insulin resistance and inflammatory response are much severe in T2DM patients with depression. hsC-RP is significantly related to depression in T2DM patients.
  【Key words】 Diabetes mellitus, type 2; Depression state; Hypersensitive C-reactive protein（hsC-RP）; Interleukin-2(IL-2); Interleukin-10(IL-10); Iuslin-like growth factor(IGF-1)