糖调节受损者早期胰岛素分泌功能与血清游离脂肪酸水平的关系  

Insulin resistance, early phase insulin secretion and serum free fatty acid levels in impaired glucose regulation subjects

作　　者：陆俊茜[1] 贾伟平[1] 李青[1] 包玉倩[1] 陈蕾[1] 项坤三[1] 

机构地区：[1]上海交通大学附属上海市第六人民医院,上海市糖尿病研究所200233

出　　处：《上海医学》2004年第7期470-472,共3页Shanghai Medical Journal

基　　金：上海市科技发展基金 ( 0 14 1190 12 );上海市医学发展基金重点研究资助项目 [0 12D0 0 2 ( 1) ]

摘　　要：目的　研究糖调节受损 (IGR)者糖负荷后游离脂肪酸变化的特点及其与胰岛素分泌功能、胰岛素抵抗的关系。方法　将 35 4例研究对象分为正常糖耐量 (NGT)组 (2 4 0例 )和IGR组 (114例 ) ,IGR组再分为空腹血糖受损 (IFG ,13例 )、糖耐量受损 (IGT ,83例 )、合并IGT和IFG(IGT +IFG ,18例 ) 3个亚组。分别采用稳态模式评估法胰岛素抵抗指数 (HOMA IR)估测胰岛素抵抗 ,以糖负荷 30min净增胰岛素与净增葡萄糖的比值(△I30 /△G30 )评估早期胰岛素分泌能力 ,以糖负荷 30min及 12 0min血清游离脂肪酸 (FFA)下降百分率评价内源性胰岛素抑制脂解能力。结果　校正年龄、性别、体重指数 (BMI)后 ,IGR各亚组HOMA IR均较NGT组显著升高 (P <0 .0 1)。校正HOMA IR后 ,IGT亚组及IFG +IGT亚组的△I30 /△G30均显著低于NGT组 (P<0 .0 1) ,而IFG亚组与NGT组的差异无显著性。IGT亚组及IFG +IGT亚组糖负荷后早期FFA降低比率显著低于NGT组 (P <0 .0 5 ) ,但各组糖负荷 2h的FFA下降百分率的差异无显著性。糖负荷后早期FFA降低比率与糖负荷后胰岛素增加比率成负相关 (r =- 0 .4 6 ,P <0 .0 0 1)。结论　糖负荷后早期FFA的代谢与胰岛素的早期分泌功能密切相关 ,中国人IGT和IFG +IGT者存在糖负荷后早期FFA代谢异常 。Objective To investigate the characteristics of free fatty acid (FFA) alteration and its relationship with insulin secretion, insulin sensitivity in impaired glucose regulation(IGR) individuals.Methods 354 individuals received 75 g OGTT and were divided into two subgroups as follows: normal glucose tolerance (NGT, n=240), impaired glucose regulation (IGR, n=114); the latter included: isolated impaired fasting glucose (IFG, n=13), isolated impaired glucose tolerance (IGT, n=83) and co-existed IFG and IGT (IFG+IGT, n=18). Insulinogenic index at 30 min (ΔI30/ΔG30, the ratio of the increment of insulin to that of plasma glucose at the 30 min after the glucose load) and HOMA-IR were performed to assess the early phase insulin secretion and insulin resistance respectively. ΔI30/fasting insulin (the ratio of the increment of insulin at 30 min to fasting insulin during OGTT) , ΔFFA 30/fasting FFA and ΔFFA120/fasting FFA (the ratio of the decrement of FFA at 30 min and 120 min to fasting FFA during OGTT)were used to estimate insulin increment rate and FFA decrement rate respectively.Results After adjusting with age, sex and BMI, HOMA-IR was increased in IFG, IGT and IFG+IGT groups correlative with NGT group (P <0.01). After adjusting with HOMA-IR, ΔI30/ΔG30 was lower in IGT and IFG+IGT groups than that in NGT (P <0.01). In IGT and IFG+IGT groups, ΔFFA30/fasting FFA were 0.21 and 0.17 respectively showing significant lowering than that of NGT group (P <0.05). ΔFFA 30/fasting FFA was correlated with ΔI30/fasting insulin negatively (r= -0.46, P< 0.001).Conclusion Insulin resistance and impairment of early phase insulin secretion were observed in subjects with isolated IGT or IFG+IGT but rarely in subjects with isolated IFG. The impaired ΔFFA 30/fasting FFAwas associated with early phase insulin secretion deficiency in isolated IGT or IFG+IGT patients.

关 键 词：糖调节受损 胰岛素分泌功能 血清游离脂肪酸 胰岛素抵抗 

分 类 号：R587.1[医药卫生—内分泌]