新诊断2型糖尿病患者一相胰岛素分泌和胰岛素敏感性评估  

Evaluation of the first-phase insulin release and insulin sensitivity in patients with newly-diagnosed type 2 diabetes

作　　者：贾伟平[1] 陆俊茜[1] 高鑫[2] 邢惠莉[3] 刘伟[4] 刘志民[5] 盛正妍[6] 胡仁明[7] 宁光[8] 邹大进[9] 冯波[10] 项坤三[1] 

机构地区：[1]上海交通大学附属第六人民医院内分泌代谢科上海市糖尿病研究所,200233 [2]复旦大学附属中山医院内分泌科 [3]上海交通大学医学院附属新华医院内分泌科 [4]上海交通大学医学院附属仁济医院内分泌科 [5]上海第二军医大学附属长征医院内分泌科 [6]上海交通大学附属第一人民医院内分泌科 [7]复旦大学附属华山医院内分泌科 [8]上海交通大学医学院附属瑞金医院内分泌代谢科 [9]第二军医大学附属长海医院内分泌科 [10]上海同济大学附属东方医院内分泌科

出　　处：《中华内分泌代谢杂志》2007年第2期100-103,共4页Chinese Journal of Endocrinology and Metabolism

基　　金：上海市科学技术发展基金[01ZD002(1)]

摘　　要：目的评估新诊断2型糖尿病患者一相胰岛素分泌与胰岛素敏感性。方法对332例新诊断2型糖尿病患者按照精氨酸刺激试验的结果分为胰岛功能正常组和异常组来评估其胰岛素分泌和胰岛素敏感性的状况。结果(1)胰岛功能正常组的体重、体重指数(BMI)、腰围、臀围、股围、空腹血清真胰岛素和甘油三酯均显著高于胰岛功能异常组(均P<0.01);(2)校正性别、年龄、BMI和腰臀比后,胰岛功能正常组的真胰岛素增值(△TI)和胰岛素抵抗指数(HOMA-IR)均显著高于胰岛功能异常组(均P<0.01);(3)胰岛素分泌功能正常伴胰岛素抵抗的个体,胰岛素分泌功能正常不伴胰岛素抵抗的个体,胰岛素分泌功能缺陷伴胰岛素抵抗的个体和胰岛素分泌功能缺陷不伴胰岛素抵抗的个体分别占总人数的35.11%、5.02%、29.78%和30.09%。结论2型糖尿病个体可分为单纯胰岛功能异常、单纯胰岛素抵抗及胰岛功能异常伴胰岛素抵抗3类,其诊断和治疗需依据此病理生理状态的评估。Objective To evaluate the first-phase insulin release and insulin sensitivity in patients with newly-diagnosed type 2 diabetes. Methods A total of 332 patients with newly-diagnosed type 2 diabetes were classified into two groups of normal or abnormal islet function according to arginine stimulation test, and their results were evaluated. Results （1） Body weight, body mass index （BMI）, waist circumference, hip circumference, femoral circumference, fasting serum true insulin and triglyceride in normal islet function group were significantly higher than those in abnormal group （all P 〈 0.01 ）. （2） After adjusting gender, age, BMI and waist to hip ratio, increment of true insulin （△TI） and insulin resistant index （HOMA-IR） in normal group were significantly higher than those in abnormal group （ both P 〈 0. 01 ）. （ 3 ） The proportion of patients of normal insulin releasing function with insulin resistance, patients of normal insulin releasing function without insulin resistance, patients of impaired insulin releasing function with insulin resistance and patients of impaired insulin releasing function without insulin resistance were 35. 11%, 5. 02%, 29. 78% and 30. 09%, respectively. Conclusion The patients with type 2 diabetes could be divided into three categories being simple islet function abnormality, simple insulin resistance and islet function abnormality combined with insulin resistance. Both diagnosis and therapy project should be based on such pathophysiological assessment.

关 键 词：糖尿病 2型 精氨酸刺激试验 一相胰岛素分泌 胰岛素抵抗 真胰岛素 

分 类 号：R587.1[医药卫生—内分泌]