2型糖尿病家系一级亲属的胰岛素抵抗和胰岛β细胞功能研究  

Insulin resistance and beta-cell function in first-degree relatives of type 2 diabetes pedigree

作　　者：黄融[1] 胡耀敏[1] 陈雅文[1] 刘伟[1] 

机构地区：[1]上海交通大学医学院附属仁济医院内分泌科,上海200127

出　　处：《上海交通大学学报（医学版）》2011年第7期937-941,共5页Journal of Shanghai Jiao tong University:Medical Science

基　　金：国家自然科学基金(30670988);上海高校选拔培养优秀青年教师科研专项基金(jdy09018)~~

摘　　要：目的评估2型糖尿病家系一级亲属不同糖耐量状态下的胰岛素抵抗状况和胰岛β细胞功能。方法 440名2型糖尿病家系一级亲属分为2型糖尿病组(T2DM组,n=144)、糖调节受损组(IGR组,n=139)和糖耐量正常组(NGT组,n=157),另选取121名无糖尿病家族史、血糖异常史和妊娠糖尿病病史的糖耐量正常者作为正常对照组(NC组)。所有受试者进行口服葡萄糖耐量试验和胰岛素释放试验,以稳态模型评估的胰岛素抵抗指数(HOMA-IR)和胰岛素作用指数(IA I)评估胰岛素敏感性,以基础胰岛素分泌功能指数(HOMA-β)、早期胰岛素分泌功能指数(ΔI30/ΔG30)、修正的胰岛β细胞功能指数(MBCI)和葡萄糖处置指数(D I)评估胰岛β细胞功能。结果与NGT组和NC组比较,T2DM组和IGR组的IAI明显降低,HOMA-IR显著升高,差异均有统计学意义(P<0.05);T2DM组的HOMA-IR也显著高于IGR组(P<0.05);NGT组与NC组的HOMA-IR和IAI比较,差异均无统计学意义(P>0.05)。胰岛β细胞功能指标比较结果显示:各项指标均为NC组>NGT组>IGR组>T2DM组,除NGT组的HOMA-β、MBC I和D I3与NC组比较差异无统计学意义外,其余指标组间比较差异均有统计学意义(P<0.05)。结论在2型糖尿病家系中糖耐量正常的一级亲属中,未发现明显的胰岛素抵抗,但已存在以早期胰岛素分泌缺陷为主胰岛β细胞功能下降。Objective To evaluate the insulin resistance and beta-cell function under different glucose tolerance status in first-degree relatives of type 2 diabetes pedigree. Methods Four hundred and forty first-degree relatives of type 2 diabetes pedigree were enrolled and divided into type 2 diabetes mellitus group(T2DM group,n=144),impaired glucose regulation group(IGR group,n=139) and normal glucose tolerance group(NGT group,n=157),and another 121 people without family history of diabetes mellitus,history of abnormal blood glucose and gestational diabetes were served as normal control group(NC group).All subjects underwent oral glucose tolerance tests and insulin releasing tests.Insulin sensitivity was estimated by homeostasis model assessment for insulin resistance(HOMA-IR) and insulin action index(IAI).Basic insulin secretion function index(HOMA-β),early insulin secretion function index(ΔI30/ΔG30),modified beta-cell function index(MBCI) and glucose disposition indices(DI) were used to evaluate the beta-cell function. Results IAI in T2DM group and IGR group were significantly lower than those in NGT group and NC group(P<0.05),while HOMA-IR in T2DM group and IGR group were significantly higher than those in NGT group and NC group(P<0.05).HOMA-IR in T2DM group was significantly higher than that in IGR group(P<0.05).There was no significant difference in HOMA-IR and IAI between NGT group and NC group(P>0.05).Comparison of parameters of beta-cell function revealed that progressive decrease was observed in each parameter from NC group,NGT group,IGR group and T2DM group,and there were significant differences in each parameter among groups(P<0.05)except for those in HOMA-β,MBCI and DI3 between NGT group and NC group. Conclusion No obvious insulin resistance is observed in first-degree relatives of type 2 diabetes pedigree with normal glucose tolerance,while there exists decrease in beta-cell function with early insulin secretion defect.

关 键 词：2型糖尿病 一级亲属 胰岛素抵抗 胰岛Β细胞功能 

分 类 号：R587.1[医药卫生—内分泌]