中国新诊断2型糖尿病胰岛素分泌和胰岛素抵抗特点调查  

Features of insulin secretion and insulin resistance in Chinese newly-diagnosed type 2 diabetes

作　　者：安雅莉[1] 高妍[3] 朱倩[4] 宁光[5] 贾伟平 黄勤[7] 许雯[8] 李成江[9] 周智广[10] 施秉银[11] 单忠艳[12] 陈璐璐[13] 许樟荣[14] 王姮 严励[16] 钟惠菊[17] 姬秋和[18] 李红[19] 薛元明 张木勋[21] 谷卫[22] 郭晓蕙[3] 高蕾丽[4] 洪洁[5] 刘芳[6] 邹大进[7] 李延兵[8] 张小英[9] 李桢[10] 郭辉[11] 赵晓娟[12] 吴汉妮[13] 王玉珍[14] 赵维纲 张少玲[16] 吴静[17] 张南雁[18] 杨凤英[19] 张云 周鑫荣[21] 任跃忠[22] 李光伟[1] 无[2] 

机构地区：[1]卫生部中日友好医院内分泌代谢中心,北京100029 [2]中国胰岛素分泌研究组 [3]北京大学第一医院内分泌科 [4]北京大学人民医院内分泌科 [5]上海交通大学医学院附属瑞金医院内分泌代谢病科 [6]上海交通大学附属上海市第六人民医院内分泌科 [7]中国人民解放军第二军医大学附属长海医院内分泌科 ,上海 [8]中山大学附属第一医院内分泌科,广州 [9]浙江大学附属第一医院内分泌科 ,杭州 [10]中南大学湘雅医学院附属第二医院内分泌科,长沙 [11]西安交通大学医学院第一附属医院内分泌科 [12]中国医科大学附属第一医院内分泌科,沈阳 [13]华中科技大学同济医学院附属协和医院内分泌科,武汉 [14]中国人民解放军三○六医院内分泌科,北京 [15]中国医学科学院协和医院内分泌科,北京 [16]中山大学第二附属医院内分泌科,广州 [17]中南大学湘雅医学院附属第一医院内分泌科,长沙 [18]中国人民解放军第四军医大学西京医院内分泌科,西安 [19]昆明医学院附属第一医院内分泌科 [20]云南省人民医院内分泌科,昆明 [21]华中科技大学同济医学院附属同济医院内分泌科,武汉 [22]浙江大学附属第二医院内分泌科,杭州

出　　处：《中华内分泌代谢杂志》2008年第3期256-260,共5页Chinese Journal of Endocrinology and Metabolism

摘　　要：目的研究中国新诊断2型糖尿病患者胰岛素分泌功能（IS）及胰岛素抵抗（IR）状况。方法对405例新诊断2型糖尿病患者和40名糖耐量正常者（对照组）测量身高、体重；行口服葡萄糖耐量试验（OGTF）及胰岛素释放试验。按空腹血糖（FPG）水平分为4组，与对照组比较。93例FPG≥8．3mmol／L者应用格列齐特（达美康）缓释片进行干预治疗1—3个月，血糖达标后重复OGTT并计算干预后的IR及IS。结果（1）随着FPG水平的升高，糖尿病各组IR、IS逐级恶化：在FPG≥9．7mmol／L组，胰岛素敏感性为正常组的30％，IS仅为正常组的5％；（2）在FPG〈9mmol／L组，IR能解释70％的血糖水平变化，而在FPG高于≥9mmol／L组，IS能解释60％的血糖变化；（3）格列齐特缓释片干预治疗IR及IS有了显著的改善。结论新诊断2型糖尿病的IR及IS随空腹血糖升高而恶化，但是IS恶化更为严重；这种双重恶化在高血糖状态得到纠正后在相当程度上是可逆的。Objective To investigate the features of insulin secretion（IS） and insulin resistance （IR） in Chinese newly-diagnosed type 2 diabetes. Methods Four hundred and five newly-diagnosed type 2 diabetic patients and forty normal controls were recruited. Their height and weight were measured, and levels of insulin and glucose at 0, 30, 60 and 120 min during oral glucose tolerance test（OGTI？） were examined. The patients were stratified to four groups based on fasting plasma glucose （FPG） level. Their IR and IS were compared to controls.Patients with FPG ≥ 8. 3 mmol/L were treated with gliclazide （ Diamicron ） for 1 to 3 months until the normalization of plasma glucose levels for more than 2 weeks. After this medication were discontinued for 48 h, OGTT were then repeated to assess changes of IR and IS. Results （ 1 ） IR was increased but IS was decreased along with the increase of FPG levels. Compared with controls, the insulin sensitivity in group with FPG ≥ 9.7 mmol/L was 30% of controls, and insulin secretion was only 5%. （2） IR could explain 70% of plasma glucose changes in the group with FPG 〈 9 mmol/L, while as in the group with FPG ≥9 mmol/L, it was the IS rather than IR explained 60% of plasma glucose changes. （3） The glucose levels in 23% of diabetic patients returned to non-diabetic range by the intervention treatment with gliclazide. Their insulin sensitivity and insulin secretion were significantly improved after the normalization of glucose. Conclusion Both IR and IS were worsen with the elevation of FPG in newly-diagnosed type 2 diabetes, however IS was worse than IR. Normalization of hyperglycemia with anti-diabetic agents can improve insulin secretion and ameliorate insulin sensitivity, suggesting that both the deficiencies seem to be reversible.

关 键 词：糖尿病 2型 胰岛素抵抗 胰岛素分泌功能 干预治疗 格列齐特 

分 类 号：R587.1[医药卫生—内分泌] R927[医药卫生—内科学]