中老年人群糖代谢异常的临床特点分析  

Clinical characteristics of glucose metabolism disorders in middle-aged and elder population

作　　者：路万虹[1] 魏丹国 施秉银[1] 徐利[1] 刘新君[1] 张丽[2] 刘娟[2] 韩凤阳 

机构地区：[1]西安交通大学医学院第一附属医院内分泌科,陕西西安710061 [2]长庆石油勘探局建设工程总公司卫生所,陕西西安710021

出　　处：《内科理论与实践》2007年第5期320-323,共4页Journal of Internal Medicine Concepts & Practice

摘　　要：目的:探讨中老年人群糖代谢异常的分布情况及其临床特点。方法:测定951例年龄≥45岁人群的身高、体重、腰围、臀围,计算体重指数(BMI)、腰臀比(WHR);口服75g葡萄糖耐量试验确定其糖代谢状态,测定血脂、空腹及餐后2h血浆血糖和血清胰岛素水平,用稳态模型评估法(HOMA)计算胰岛素抵抗(IR)指数(HOMA-IR)、胰岛细胞功能指数(HOMA-β),进行组间比较。结果:①糖耐量正常者(NGT)占53.00%,单纯糖耐量异常(IGT)占25.34%;空腹血糖受损(IFG)占5.15%;IFG合并IGT占3.79%;糖尿病(DM)占12.72%;②IGT、IFG+IGT、DM患者的年龄、血压、脉压、BMI显著高于NGT和IFG者;WHR值按NGT、IFG→IGT→IFG+IGT、DM的顺序依次增高(P<0.05);IGT、IFG+IGT、DM者的三酰甘油(TG)水平高于NGT者(P<0.05),其中隐性糖尿病(LDM)和显性糖尿病(ODM)患者的TG水平又显著高于IFG者(P<0.05);③IR的程度按NGT、IGT→IFG→LDM→IFG+IGT→ODM的顺序依次升高;除IGT外,其他糖代谢异常的IR程度均显著高于NGT(P<0.05);HOMA-β按IGT、NGT→LDM→IFG+IGT→IFG→ODM的顺序依次降低;各组中以ODM的IR最高,基础胰岛素分泌功能最差。结论:中老年人群的糖代谢异常的患病率高,应重视对餐后血糖的检测,合并有中心性肥胖、高血压等危险因素者建议做口服葡萄糖耐量试验以明确诊断。中老年人群中糖代谢异常者普遍存在IR及胰岛β细胞分泌功能不足。Objective To investigate the clinical characteristics of glucose metabolism disorders in middle-aged and elderly population. Methods Glucose metabolism disorders related examinations, including body height, weight, waist/hip ratio （WHR）, body mass index （BMI）, oral glucose tolerance test （OGTT）, serum insulin and lipid, were conducted in 951 middle-aged and elder people （with cut-off value of 45 years old）, homeostasis model assessment of insulin resistance （HOMA-IR） and HOMA-β were calculated simultaneously. Results ① The percentages of population with normal glucose tolerance （NGT）, impaired glucose tolerance （IGT）, impaired fasting glucose（IFG）, IFG＋IGT, and diabetes mellitus （DM） were 53.00%, 25.34%, 5.15%, 3.79% and 12.72%, respectively. ② The values of age, blood pressure, BMI were higher in IGT, IFG＋IGT, DM groups than those in NGT, IFG groups（P〈0.05）. The value of WHR was progressively increased with the following sequences： NGT, IFG→GT→FG＋IGT, DM（P〈0.05）. Serum triglyeride （TG） levels were higher in IGT,IFG＋ IGT,DM groups than those in NGT （P〈0.05） groups.③ The severity of insulin resistance were worse with the following sequencing NGT, IGT→IFG→atent diabetes （LDM）→FG＋IGT→overt diabetes （ODM） （P〈0.05）; HOMA-β decreased as following sequencing： IGT,NGT→DM→FG＋IGT→FG→ODM （P〈0.05）. Conclusions The incidence of glucose metabolism disorders was high in middle-aged and elderly population; much attention should be focused for post prandial glucose in this population, especially in those who concomitantly with central obesity, hypertension and hyperlipidemia. OGTT is highly recommended to select for the middle-aged and elder population. Insulin resistance and β-cell secretion deficiency are generally existing in glucose metabolism disorders. LDM might be the consequence of IGT, and related with the severe insulin resistance and declining function of β-cells.

关 键 词：中老年人群 空腹血糖受损 糖耐量减退 糖尿病 胰岛素抵抗 

分 类 号：R587.1[医药卫生—内分泌]