血脂异常对胰岛β细胞功能和胰岛素敏感性的影响  

Evaluation of insulin resistance and islet B cell function in dyslipidemia subjects with normal blood glucose

作　　者：李佳[1] 徐玲[1] 蒋岚[1] 

机构地区：[1]泸州医学院附属医院内分泌科,四川泸州646000

出　　处：《重庆医学》2010年第17期2264-2266,2269,共4页Chongqing medicine

摘　　要：目的用Botnia钳夹术评价血脂异常患者胰岛β细胞功能和胰岛素敏感性。方法对糖耐量正常的15例血脂正常者和15例高脂血症患者分别进行Botnia钳夹术,评价高脂血症患者胰岛细胞功能和胰岛素敏感性。以正糖钳夹稳态期胰岛素介导的葡萄糖利用率(Rd)来判定周围组织胰岛素敏感性,以IVGTT测定的第一时相胰岛素分泌(FPIR)与Rd值的乘积——处置指数来判定胰岛β细胞功能。结果血脂异常组Rd明显低于血脂正常组(P=0.009),基础胰岛素水平明显高于血脂正常组(P=0.002),Botnia钳夹术测定的FPIR,血脂正常者和血脂异常者差异无统计学意义(P>0.05),但用Rd校正后得出的处置指数值,血脂异常者明显低于血脂正常者(P=0.011)。Rd与血清游离脂肪酸明显负相关(r=-0.577),FPIR与游离脂肪酸、尿酸明显负相关(r=-0.446;r=-0.391)。结论血糖正常的血脂异常患者存在外周胰岛素抵抗与胰岛β细胞功能异常,高游离脂肪酸血症可能在其中发挥重要作用。Objective To detect the influence between peripheral insulin resistance and islet β cell function in dyslipidemia subjects with normal blood glucose.Methods The Botnia clamp,an intravenous glucose tolerance test followed by a euglycemic-hyperinsulinemic clamp,was performed in 15 normal subjects and 15 cases of dyslipidemia with normal glucose tolerance.The rate of insulin-mediated glucose disposal（Rd）during the steady state of glucose clamp was used to assess the peripheral tissue insulin sensitivity.The disposition index（DI） was used to measure insulin secretion adjusting for insulin sensitivity and was calculated from the product of the FPIR and the Rd.Results Dyslipidemia patients showed decreased Rd（6.27±2.59 mg·kg^-1·min^-1s 9.03±2.78 mg·kg^-1·min^-1=0.009）,but similar FPIR,compared with healthy people.However,insulin secretion adjusting the degree of insulin resistance was significantly impaired（P=0.011）.The Rd was significantly correlated negatively with free fatty acids（FFA）（r=-0.577,P〈0.05）.FPIR was significantly correlated negatively with the FFA and uric acid（r=-0.446,r=-0.391,P〈0.05）.Conclusion In dyslipidemia subjects with normal blood glucose,there are severe peripheral insulin resistance and relative deficiency of cell first-phase insulin release.It is logical to deduce that both insulin resistance and the cell changes could be,at least partially,secondary to high levels of serum FFAs.

关 键 词：静脉葡萄糖耐量试验 葡萄糖钳夹技术 血脂异常 胰岛素抵抗 胰岛Β细胞 

分 类 号：R587.1[医药卫生—内分泌]