上海地区肥胖糖调节受损者的胰岛素敏感性和1相胰岛素分泌功能研究  

Insulin sensitivity and first-phase insulin secretion in obese subjects with impaired glucose regulation in Shanghai

作　　者：洪洁[1] 顾卫琼[1] 张翼飞[1] 杨义生[1] 沈春芳[1] 桂明辉[1] 王卫庆[1] 赵咏桔[1] 宁光[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院内分泌科上海市内分泌代谢病临床医学中心上海市内分泌代谢病研究所,200025

出　　处：《中华内分泌代谢杂志》2006年第4期347-350,共4页Chinese Journal of Endocrinology and Metabolism

基　　金：上海市卫生局攻关课题(2001ZD002);国家自然基金(30270625);上海教委曙光计划(01SG48);上海市教委重点学科建设经费(2001);上海市高等学校青年科学基金项目(04BCA2)

摘　　要：目的研究上海地区肥胖的糖调节受损(IGR)者胰岛素敏感性和胰岛β细胞1相胰岛素分泌功能。方法共有129例受试者[非肥胖正常对照38名,IGR包括单独糖耐量受损(IGT)64例,单独空腹血糖受损(IFG)8例,IFG+IGT 19例]接受了口服75g葡萄糖耐量试验和胰岛素改良的减少样本数(n =12)的Bergman微小模型技术结合频繁采血的静脉葡萄糖耐量试验(FSIGTT)。胰岛素抵抗由FSIGTT中胰岛素敏感性指数(S1)加以评估,而FSIGTT中对葡萄糖急性胰岛素分泌反应(AIRg)则用以评价胰岛β细胞分泌功能。处理指数(DI=AIRg×S1)用于评价AIRg是否代偿机体的胰岛素抵抗。结果(1)与正常对照组相比,3组IGR患者之S1明显降低(均P<0．01),3组差异无统计学意义;(2)AIRg在正常组和IGT组之间差异无统计学意义,但均大于IFG和IFG+IGT组,差异有统计学意义(P<0．05或JP<0．01)。IFG +IGT组的AIRg值显著低于IGT组(P<0．01);(3)与正常组相比,DI指数在3组IGR显著降低(P< 0．01),但在IGR组间差异无统计学意义;(4)S1与空腹胰岛素、体重指数、血清尿酸呈显著负相关(校正r2 =0．568,P<0．01);而AIRg与2h胰岛素显著正相关,与空腹血糖、2h血糖和年龄负相关(校正r2=0．402, P<0．01)。结论上海地区肥胖的初诊IGR患者(包括单独IGT、单独IFG和IFG+IGT患者)存在着程度近似的胰岛素抵抗;急性相胰岛素分泌功能在校正胰岛素抵抗影响因素后IGT患者尚属正常,在IFG和IFG+IGT患者已明显降低,且3组的β细胞代偿功能均为一致性失代偿。Objective To study insulin sensitivity and first-phase insulin secretion in obese subjects with impaired glucose regulation （IGR） in Shanghai. Methods A total of 129 subjects [ 38 lean controls and 91 obese subjects with IGR including 64 isolated impaired glucose tolerance （IGT） , 8 isolated impaired fasting glucose （IFG） and 19 IFG ＋ IGT] underwent 75 g oral glucose tolerance test and insulin-modified reduced sample number （n = 12 ） of Bergman＇ s minimal model method with frequently sampled intravenous glucose tolerance test （FSIGTT）. Insulin resistance was determined from the insulin sensitivity index （ SI ） of the FSIGTT. Insulin secretion was determined during the FSIGTT by the acute insulin response to glucose （AIRg）. The disposition index （ DI）, the product of AIRg and SI, was used to determine whether AIRg was adequate to compensate for insulin resistance. Results （ 1 ） Compared with normal controls, the value of SI was significantly decreased in 3 groups with IGR （ all P 〈0.01 ） and there was no significant difference in SI among the 3 groups; （ 2 ） AIRg in control group was similar to that of the IGT group and was significantly greater than those in IFG and IFG ＋ IGT group （ P 〈0.05 or P 〈0.01 ） , and the difference between IGT and IFG ＋ IGT groups was significant （ P 〈0.01 ） ; （ 3 ） Compared with normal group, the DI value was significantly decreased in the 3 groups with IGR （ all P 〈 0.01 ） , and there was no significant difference among these 3 IGR groups; （4） SI was negatively correlated with fasting insulin, body mass index, and serum uric acid （ adjusted r： = 0. 568, P 〈 0.01 ）. AIRg was positively correlated with 2 h insulin and negatively correlated with fasting plasma glucose, 2 h plasma glucose and age （adjusted r^2 = 0.402, P 〈0.01 ）. Conclusion Newly diagnosed obese patients with IGR （including isolated IGT, isolated IFG and IFG ＋ IGT） in Shanghai have a similar degree of insulin resistance,

关 键 词：糖调节受损 糖耐量受损 空腹血糖受损 胰岛素抵抗 急性胰岛素反应 

分 类 号：R589.2[医药卫生—内分泌] R587.1[医药卫生—内科学]