糖耐量正常者和糖耐量低减者互相转化过程中胰岛素敏感性和胰岛β细胞分泌功能的改变  

Insulin sensitivity and pancreatic beta cell function changes during the transformation from normal to impaired glucose tolerance

作　　者：李静[1] 严励[1] 陈黎红[1] 李焱[1] 黎锋[1] 刘顺莲[1] 戚以勤[1] 程桦[1] 

机构地区：[1]中山大学附属第二医院内分泌科,广州510120

出　　处：《中华内科杂志》2007年第10期842-845,共4页Chinese Journal of Internal Medicine

摘　　要：目的了解胰岛素敏感性和胰岛β细胞功能在2型糖尿病发病中的作用。方法以静脉葡萄糖耐量试验刺激后急性胰岛素反应(AIR_(3-5))表示第一时相胰岛素分泌功能指数,采用口服葡萄糖耐量试验30min 与空腹时胰岛素差值与血糖差值比(ΔI_(30)/ΔG_(30))反映早期相胰岛素分泌功能;Cederholm 提出的胰岛素敏感性指数(ISI)评估胰岛素敏感性。分析70例非糖尿病者3年追踪结果,其中糖耐量正常(NGT)转变为糖耐量低减(IGT)组(进展 NGT 组)9例,NGT 无进展组45例,IGT逆转为 NGT 组(IGT 好转组)16例。结果(1)AIR_(3-5):进展 NGT 组与 NGT 无进展组间基线时比较差异无统计学意义;3年后两组 AIR_(3-5)均无明显变化,且与基线时比较差异仍无统计学意义;IGT 好转组3年后较基线时升高但差异无统计学意义。(2)ΔI_(30)/ΔG_(30):进展 NGT 组与 NGT 无进展组间基线时比较差异无统计学意义,3年后两组均无明显变化,组间比较差异仍无统计学意义;IGT 好转组3年后与基线比较差异亦无统计学意义。(3)ISI:基线时进展 NGT 组与 NGT 无进展组间比较差异无统计学意义;3年中进展 NGT 组的 ISI 明显下降,3年后与基线时比差异有统计学意义;而 NGT 无进展组基线时与3年后的 ISI 差异无显著意义。NGT 进展组和 NGT 无进展组间追踪后比较差异有统计学意义。IGT 好转组追踪后 ISI 较基线时明显好转,前后差异有统计学意义。(4)logistic 回归分析显示,AIR_(3-5)、ΔI_(30)/ΔG_(30)、ISI 3个指标中,仅 ISI 对 NGT 向 IGT 转变的影响有统计学意义。结论本组人群由 NGT 向 IGT 进展过程中,胰岛素敏感性明显下降,而胰岛β细胞功能改变不明显;而由 IGT 逆转为NGT 的过程中,胰岛素敏感性显著改善,而胰岛β细胞功能无明显改变。提示在2型糖尿病发病的早期阶段,即由 NGT 向 IGT 的进展过程中,胰岛素抵抗起主要作用。Objective To investigate the roles of insulin sensitivity and pancreatic beta cell function in the pathogenesis of type 2 diabetes. Methods 70 subjects were recruited in a 3-year prospective study. During this period 9 subjects progressed from normal glucose tolerance（NGT） to impaired glucose tolerance （IGT）（progressing group）, 45 remained same（remaining group） and 16 improved from IGT to NGT （improving group）. Acute insulin secretion response （AIR3-5 ）during intravenous glucose tolerance test （IVGTT） was adopted to indicate the first phase insulin secretion with the ratio of insulin change from 0 min to 30 min to that of blood glucose from 0 min to 30 min （ △I30/△G30 ） as the indicator of early insulin secretion and insulin sensitivity （ISI） was analyzed by the formula suggested by Cederholm during oral glucose tolerance（OGTT）. Results （ 1 ） For AIR3-5 , there were no differences of the baseline level and the 3-year follow-up state between the progressing group and remaining group; neither there were differences between the baseline level and the 3-year follow-up state in both groups. Meanwhile, in the improving group, AIR3-5 increased after the 3-year follow-up time as compared with that at the baseline, but without significance. （2） For △I30/△G30, there were no differences of the baseline level and the follow-up state between the progressing group and remaining group; neither there were differences between the progressing group and remaining group baseline level and the 3-year follow-up state in both groups. Meanwhile, in the improving group, there was no difference between that at baseline and at the follow-up. （3） For ISI, although there was no significant difference between the progressing group and remaining group at the baseline level, yet that at the 3-year follow-up state was different between the progressing group and remaining group with ISI in the progressing group decreased significantly; ISI in improving group increased significantly at th

关 键 词：糖尿病 2型 胰岛素抗药性 早期相胰岛素分泌 

分 类 号：R587.1[医药卫生—内分泌]