口服葡萄糖耐量试验中30分钟和(或)60分钟高血糖者胰岛素敏感性及1相胰岛素分泌功能的研究  

A study on insulin sensitivity and first-phase insulin secretion in obese patients with hyperglycemia at 30' and/or 60' during OGTT

作　　者：洪洁[1] 顾卫琼[1] 张翼飞[1] 沈春芳[1] 徐敏[1] 桂明辉[1] 王卫庆[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：《中国糖尿病杂志》2007年第5期273-277,共5页Chinese Journal of Diabetes

基　　金：上海市卫生局攻关课题资助项目(2001ZD002);上海市高等学校青年科学基金资助项目(04BC42)

摘　　要：目的研究肥胖的口服葡萄糖耐量试验(OGTT)中30min和(或)60min高血糖者(PLH)胰岛素抵抗和胰岛素分泌功能。方法共有165位受试者包括正常对照(NC)、单纯性肥胖(NGT)、肥胖PLH和肥胖糖耐量低减(IGT)接受了OGTT和静脉葡萄糖耐量试验。用HOMA-IR和SI评估胰岛素抵抗,△I30/△G30和AIRg评价β细胞功能,处理指数(DI=AIRg×SI)评价AIRg对胰岛素抵抗的代偿度。结果与NC组相比,NGT、PLH、IGT组的HOMA-IR升高,SI降低,后三组间差异无统计学意义。与NC、PLH和IGT组比较,NGT组AIRg升高,前三组间无统计学差异;与NC、PLH和IGT组比较,NGT组△I30/△G30升高,PLH组△I30/△G30高于NC组,而PLH和IGT组间以及NC和IGT组间△I30/△G30无统计学差异。与NC组相比,NGT、PLH、IGT组DI指数降低;NGT组DI指数高于PLH和IGT组,后二组间差异无统计学意义。结论上海地区肥胖的PLH人群与肥胖的IGT患者存在着程度近似的胰岛素抵抗和β细胞功能缺陷。Objective To investigate insulin sensitivity and insulin secretion in obese patients with post-loading hyperglycemia （PLH） at 30 and/or 60 minutes during OGTT. Methods A total of 165 subjects, including lean controls （NC, n=38）, simple obesity （NGT, n=49）, obesity with PLH（n=22） and obesity with IGT（n= 56）, underwent 75 g OGTT and frequently sampled intravenous glucose tolerance test. Insulin resistance was determined by HOMA-IR and by insulin sensitivity index （Sl）. Insulin secretion was determined by ΔI30//ΔG30 and by acute insulin response to glucose （AIRg）. The disposition index （DI）, the product of AIRg and S1, was used to determine whether AIRg was adequate to compensate for insulin resistance. Results Compared with NC, HOMA-IR was significantly increased and S1 was decreased in groups of NGT, PLH and IGT and with no significant difference between each other. AIRg was significantly increased and greater in NGT group than in NC, PLH and IGT groups and there was no significant difference among the latter three groups. ΔI30/ΔG30 was significantly increased and higher in NGT group than in NC, PLH and IGT groups. This index was significantly higher in PLH than in NC, and there was no significant difference between PLH and IGT groups and between NC and IGT groups. Compared with NC group, the DI value was significantly decreased in those three groups, and was significantly higher in NGT group than in PLH and IGT groups, and there was no significant difference between the latter two groups. Conclusions Obese patients with hyperglycemia at 30 min and/or 60 rain during OGTT in Shanghai area have a similar degree of insulin resistance and dysfunction of β cell to those obese patients with IGT.

关 键 词：肥胖 葡萄糖耐量试验 糖负荷后高血糖症 胰岛素抵抗 

分 类 号：R587[医药卫生—内分泌]