不同阶段糖尿病β细胞功能和胰岛素抵抗及其相关因素分析  

Islet β-cell function,insulin resistance and its correlative factors in Chinese with different status of glucose metabolism

作　　者：朱敏[1] 史虹莉[2] 方京冲[1] 胡敏[1] 

机构地区：[1]复旦大学附属华山医院老年病科,上海200040 [2]复旦大学附属华山医院内分泌科,上海200040

出　　处：《复旦学报（医学版）》2006年第3期336-339,共4页Fudan University Journal of Medical Sciences

基　　金：上海市科技攻关项目(034119908)资助

摘　　要：目的探讨从正常糖耐量(NGT)到糖尿病不同糖代谢水平,胰岛素抵抗(IR)与胰岛β细胞功能的演变及其相关因素。方法2型糖尿病(DM)841例分成新诊断糖尿病组以及按病程每5年分为一组,直到>15年共5组。糖耐量异常(IGT)29例,NGT133例。比较各组的体重指数(BMI)、腰臀比(WHR)、血压、血脂、空腹血糖(FPG)和胰岛素(FINS)水平。采用稳态模型评估β细胞功能(HOMA-β)和胰岛素抵抗(HOMA-IR)。结果在从NGT到DM发病过程中,随着FPG的逐渐升高,血浆FINS水平也逐渐升高,新诊断DM患者的血浆FINS水平达到最高峰,以后逐渐回落。IGT和NGT两组的HOMA-β无明显统计学差异,而DM各组随着病程的延长,HOMA-β明显下降(P<0.05)。HOMA-IR在IGT组就比NGT组明显增高,DM各组随病程持续升高。Pearson相关分析显示,HOMA-β与病程、FPG负相关(P<0.001);HOMA-IR与病程、BMI、WHR、舒张压(DBP)、FPG、FINS、三酰甘油(TG)正相关(P<0.001)。结论在IGT阶段就存在明显的胰岛素抵抗,从NGT向DM的转化过程中,β细胞的功能逐渐减退,胰岛素抵抗贯穿其中。β细胞的功能减退和胰岛素抵抗与血糖、血压、血脂、肥胖均有关。Purpose To investigate the change of insulin resistance （IR）, function of β-cell and its correlative factors. Methods Subjects of diabetic patients grouped by newly diagnosed and by five years duration added till to greater than 15 years（DM, n = 841）, isolated impaired glucose tolerance （IGT, n = 29）, normal glucose tolerance （NGT, n = 133） were studied. Body mass index（BMI）, waist hip ratio（WHIR）, blood pressure （BP）, blood lipid, fasting plasma glucose（FPG）, fasting insulin（FINS） were compared among the groups. Homeostasis model assessment （HOMA） was applied to assess the status of β-cell function （HOMA-β） and insulin resistance （HOMA-IR）. Results During the progression to diabetes, FINS increased along with the gradually elevated glucose level. In newly diagnosed diabetes, it reached to its maximal peek, and then slowly declined. There was no significant difference between NGT and IGT in HIOMA-β, but in the groups of DM, HIOMA-β were notably decreased along with the course of disease. When compared to NGT, HOMA-IR was already much higher in IGT, and still remained at high level in DM. Pearson correlation analysis demonstrated that course of disease, FPG were negatively correlated with HOMA-β （P〈0.001） ; course of disease, BMI, WHR, diastolic blood pressure（DBP）, FPG, FINS and triglyceride （TG） were positively correlated with HOMA-IR（P〈0. 001）. Conclusions Insulin resistance is already existed in IGT status. Islet β cell function decreased gradually from NGT to DM, insulin resistance throughout the transition. They are correlated with FPG, BP, blood lipid, and obsess.

关 键 词：胰岛素抵抗 Β细胞功能 糖代谢 

分 类 号：R587.1[医药卫生—内分泌]