单纯性肥胖患者外周胰岛素抵抗与﹀细胞功能的研究  

Relationship between Peripheral Insulin Resistance and β-cell Function in Obese Subjects

作　　者：李宏亮[1] 余叶蓉[1] 喻红玲[1] 王椿[1] 张祥迅[1] 

机构地区：[1]四川大学华西医院内分泌科,成都610041

出　　处：《四川大学学报（医学版）》2005年第3期378-381,共4页Journal of Sichuan University(Medical Sciences)

摘　　要：目的　研究血糖“正常”的单纯性肥胖患者胰岛素抵抗与β细胞功能的关系,探讨游离脂肪酸(FFA)在2型糖尿病(T2 DM)发病中的作用。方法　10例血糖“正常”的单纯性肥胖患者和10例年龄、生活习惯相匹配的非肥胖者(对照) ,均不吸烟、血压及血胆固醇正常。所有研究对象均完成以下检查:1空腹血脂及FFA。2血清免疫活性胰岛素(IRI)、前胰岛素(PI)及真胰岛素(TI) ;3静脉注射葡萄糖后早相胰岛素分泌反应(AIR) ;4正常血糖高胰岛素钳夹试验,评价外周组织葡萄糖的摄取率(GDR)。结果　肥胖患者IRI、PI和TI增高,PI/ (PI+TI)比值也高于对照组(P<0 .0 1)。肥胖患者AIR增高,曲线下面积也高于对照组(P<0 .0 5 ) ,但肥胖患者在3、5及10 min的血糖也高于对照组(P<0 .0 5 )。肥胖组达到稳态时GDR明显降低(P<0 .0 5 )。肥胖组血脂除TG增高(P<0 .0 5 )外,其余正常。血FFA浓度高于正常组(P<0 .0 5 )。肥胖组血FFA与GDR成负相关(r=- 0 .76 7,P<0 .0 1)。结论　血糖“正常”的单纯性肥胖患者存在外周胰岛素抵抗与β细胞功能异常,且二者可能同时发生。高FFA血症可导致外周胰岛素抵抗与β细胞功能异常。Objective To detect the relationship between peripheral insulin resistance and β-cell function in obese subjects with normal blood glucose, and to explore the role of free fatty acids (FFAs) in the pathogenesis of type 2 DM. Methods Ten simple obesity male subjects(OB) with normal blood glucose and 10 lean male persons(NC) matched on age and living style were included. None of them was smoker, and their blood pressure, serum cholesterol levels were all normal. All subjects underwent the following tests: ①Fasting serum lipids profile and FFA; ②Baseline immunoreactive insulin(IRI), pro-insulin(PI) and true-insulin(TI);③Acute insulin response(AIR) to an intravenous bonus of glucose;④Euglycemic hyperinsulinemia clamp study to assess the peripheral glucose disposal rate (GDR). Results In obesity subjects, the baseline IRI, PI and TI were elevated and the ratio of PI/(PI+TI) was higher than controls (P<0.01). The AIR was enhanced in OB and the area under the curve was larger (P<0.05), but in obesity subjects the plasma glucose levels at 3, 5 and 10 minutes were much higher than controls (P<0.05). The GDRs obtained during steady state were markedly decreased in OB (P<0.05). The serum lipids profiles were normal except that triglyceride was higher in OB (P<0.05) and the FFAs concentration was also elevated in OB (P<0.05). There was a negative correlation between FFAs concentration and GDR in OB groups (r=-0.767, P<0.01). Conclusion The present data showed that in obese subjects with normal blood glucose, there were severe peripheral insulin resistance, relative deficiency of β-cell first-phase insulin release and increased ratio of pro-insulin to insulin. It is logical to deduce that both insulin resistance and the β-cell changes could be, at least partially, secondary to high levels of serum FFAs. Elevated circulating FFAs may paly a role in the pathogenesis of type 2 DM.

关 键 词：肥胖症 脂毒性 胰岛Β细胞功能 

分 类 号：R589.2[医药卫生—内分泌]