160例糖耐量受损患者5年随访观察  

Follow-up survey of 160 subjects with impaired glucose tolerance for 5 years

作　　者：邓宏明[1] 肖常青[1] 潘海林[1] 夏宁[1] 李世生[1] 于志清[1] 

机构地区：[1]广西医科大学代谢糖尿病研究中心,南宁530021

出　　处：《中华糖尿病杂志（1006-6187）》2004年第4期238-241,共4页

摘　　要：目的　研究糖耐量受损 (IGT)演变过程中胰岛素抵抗 (IR)和胰岛素分泌 (IS)功能的变化。　方法　对 16 0例IGT患者完成 5年追踪观察后 ,按 1999年WHO糖尿病 (DM)诊断标准进行分类 ,其中 4 1例转变成DM (2 5 6 % ) ,4 8例转为正常糖耐量NGT (30 0 % ) ,71例维持在IGT(4 4 4 % )。据此 ,将 16 0例IGT患者分成两组 :糖尿病转化 (DM )组和非糖尿病转化 (NDM)组。　结果　 (1)DM与NDM两组比较 ,5年前初始点的葡萄糖耐量试验 1h血糖 (1hBG1st)、血糖曲线下面积(AUCBG1st)、空腹胰岛素 (FIns1st)和胰岛素抵抗指数 (HOMA IR1st)均显著升高 (P <0 0 5 ) ,但胰岛素分泌指数 (HOMA IS1st)差异无显著意义 (P >0 0 5 ) ;(2 ) 5年后 ,HOMA IR2nd和HOMA IS2nd两组比较差异有非常显著意义 (P <0 0 1) ,DM组HOMA IR2nd明显增高 ,而HOMA IS2nd显著降低 ;(3)以DM的发生与否为二分变量 ,以 5年前的胰岛素曲线下面积 (AUCIns1st)、AUCBG1st、FBG1st、1hBG1st、2hBG1st、体质指数 (BMI1st)、腰臀比 (WHR1st)、甘油三酯 (TG1st)、总胆固醇 (TC1st)、HOMA IR1st、HOMA IS1st为协变量进行Logistic回归分析 ,能进入此回归方程的变量为 :HOM IR1st、1hBG1st;(4 )ROC曲线分析表明 ,1hBG1st对IGT患者 5年后发生DM有预测作用 ,且?Objective To study the changes of insulin resistance(IR) and insulin secretion(IS) of 160 impaired glucose tolerance ( IGT) subjects before and after 5 years follow up. Methods 160 IGT subjects were surveyed in follow-up for 5 years without intervention. 38 cases of all subjets returned to diabetes mellitus (DM) and 49 cases to normal g lucose tolerance (NGT), but 73 cases remained IGT. Thus, 160 IGT subjects were divided into two groups according to diabetic diagnosis criteria of WHO,1999: DM group (38 case) and non-DM group (122 cases). Results (1) There was significant difference between DM and non-DM groups in 1 hBG 1st , AUC BG1st,FIns 1st and HOMA-IR 1st. At the beginning, these v ariables were higher in DM group than those in non-DM group. But there was no significant difference in HOMA-IR 1st between the two groups. (2)HOMA- IR 2nd was higher and HOMA-IS 2nd was lower in DM groups than those i n non-DM group after five years. (3)Logistic analysis was made with dependen t variable of existence of DM after 5 years and covariables of AUC Ins1st,A UC BG1st, FBG 1st, 1 hBG 1st, 2 hBG 1st,BMI 1st,WHR 1st,TCH 1st,TG 1st, HOMA-IR 1st, and HOMA-IS 1st, and on ly 1 hBG 1st and HOMA-IR 1st entered the equation. (4)ROC analysis showed that 1 hBG 1st could predict the change of IGT to DM. Effect of 1 hBG 1st prediction at the beginning was better than that of FBG 1st an d 2 hBG 1st. Conclusion (1)IGT results mainly from IR ;(2)The return of IGT to DM not only depends on IR, but also on the decrease o f IS; (3) 1 hBG 1st and HOMA-IR 1st can predict the return of IGT to DM.

关 键 词：糖耐量受损 胰岛素抵抗 胰岛素分泌 糖尿病 

分 类 号：R587.1[医药卫生—内分泌]