糖尿病前期人群健康教育一年后转为正常血糖者第二年的自然转归  

Two-year follow-up for patients with pre-diabetes that reverted to normal glucose in the first year

作　　者：卢艳慧[1] 陆菊明[2] 王淑玉[3] 李春霖[1] 刘力生[3] 郑润平[3] 田慧[1] 王先令[2] 杨丽娟[2] 张育青[2] 潘长玉[2] 

机构地区：[1]解放军总医院老年内分泌科,北京100853 [2]解放军总医院内分泌科,北京100853 [3]北京高血压联盟研究所

出　　处：《中华医学杂志》2008年第20期1394-1397,共4页National Medical Journal of China

基　　金：首都医学发展科研基金北京医学卫生科技联合攻关项目基金资助（2002-1009）

摘　　要：目的采用2003年美国糖尿病协会标准分析糖尿病前期人群健康教育1年后转为正常血糖（NGT）者第2年的自然转归及影响因素。方法北京地区中老年人群流行病学调查筛查出的糖调节受损（IGR）者健康教育1年后逆转为NGT者169例第2年再次随访。结果基线时IGR人群1年后逆转为NGT的169例中第2年复查时90例（53．3％）仍维持NGT，77例（45．6％）又转为IGR，2例（1．2％）进展为糖尿病。IGR→NGT→NGT组第2年的胰岛素抵抗显著减轻，胰岛β细胞功能显著改善（P〈0．05）。逐步回归分析显示基线及1年后的空腹血糖（FPG）与IGR向NGT的转归及维持呈负相关，基线及1年后的胰岛β细胞功能与IGR向NGT的转归及维持呈正相关。IGR→NGT→NGT组第2年时腰围超标（46例）、血压升高（41例）、甘油三酯（TG）升高（23例）、≥2项代谢异常及代谢综合征（46例）的比例均显著低于IGR→NGT→NGT组（分别为53、52、34-68例，P〈0．05）。结论FPG、胰岛β细胞功能、TG等因素可以作为IGR逆转为NGT并维持NGT的预测指标。合并的代谢异常项目越少，改善越明显，对于IGR人群逆转为NGT并维持NGT越有益。Objective To investigate the natural outcome in the second year of the patients with impaired glucose regulation （IGR）that reverted to normal glucose tolerance （NGT）. Methods 463 adults diagnosed as with IGR in the baseline survey based on the criteria of America Diabetic Association 2003 underwent treatment including health education. One and 2 years later blood samples were collected to examine the glucose and lipids. Blood pressure, heart rate, waist, and hip were examined. Questionnaire survey was conducted. Results One year later 55 of the patients （32.5%） were diagnosed as with isolated impaired glucose tolerance （I-IFG）, 86 （50.9%） with I-IGT, and 28 （ 16. 6% ） with IFG/IGT at the baseline survey had their diseases reverted to NGT. 53.3% of them remained to be with NGT, 45.6% of them showed the diagnosis transformed into IGR, and the disease in 1.2% of them progressed into diabetes mellitus. In the second year, insulin resistance was significantly relieved and islet β cell function was significantly improved in the pattern IGR→NGT→NGT. Stepwise logistic regression analysis showed that fasting plasma glucose （FPG） in the baseline survey and 1 year later were negatively correlated and HBCI were positively correlated with the reversion and maintenance of NGT. In the second year, the ratio of elevated waist circumference, elevated blood pressure, elevated TG, reduced HDL-c, elevated FPG, more than two metabolic abnormalities and metabolic syndrome of the IGR→NGT→NGT group were significantly lower than in the IGR→NGT→NGT group （ all P 〈 0.05 ）. Conclusion FPG, islet βcell function and TG can be considered as indicators for reversion from IGR to NGT and maintenance of NGT. Those with less metabolic abnormalities at baseline and with more obvious improvement would be more likely to revert to and maintain NGT.

关 键 词：糖尿病前期 胰岛素抗药性 糖调节受损 胰岛Β细胞功能 

分 类 号：R686[医药卫生—骨科学]