初诊2型糖尿病患者长期综合干预对糖代谢转归的影响  

Effect of long-term integrated intervention on outcomes for glucose metabolism in newly diagnosed type 2 diabetic patients

作　　者：陈雅静[1,2] 杨建梅[1] 林远[1] 王虹[1] 邵大霞[1] 郭晓蕙[1] 

机构地区：[1]北京大学第一医院内分泌科,100034 [2]河北省保定市第二医院

出　　处：《中国糖尿病杂志》2010年第8期571-575,共5页Chinese Journal of Diabetes

基　　金：国家"十五"科技攻关项目(2004BA702B)

摘　　要：目的探讨长期综合干预2型糖尿病(T2DM)患者糖代谢的转归及影响因素。方法对129例初诊T2DM患者进行为期6年的综合干预,定期随访,监测体重指数(BMI)、腰臀比(WHR)、血压、血脂、空腹血糖(FPG)及餐后2小时血糖(2hPG)、糖化血红蛋白(HbA_1c)及空腹胰岛素(FIns),计算胰岛素敏感指数(ISI)及胰岛素抵抗指数(HOMA-IR)。随访结束时行75g口服葡萄糖耐量试验(OGTT),据此将患者分为DM组和非DM(NDM)组,后者包括正常糖耐量(NGT)、糖耐量受损(IGT)、空腹血糖受损(IFG)及IGT+IFG,分析DM的转归及影响因素。结果 (1)129例T2DM患者6年后有14例(10.9%)转变为NGT,27(20.9%)例转变为IGT、IFG或IGT+IFG,88例(68.2%)仍为DM。(2)NDM组基线时FPG、WHR、甘油三酯(TG)低于DM组;终点时WHR、HbA_1c、FPG、2hPG水平低于DM组,高密度脂蛋白胆固醇(HDL-C)高于DM组;两组治疗后BMI、HDL-C的变化值(△BMI、△HDL-C)差异有统计学意义。(3)基线时两组OGTT试验各点胰岛素水平、HOMA-IR及ISI无显著性差异,终点时NDM组OGTT试验0.5h、1h胰岛素水平及ISI高于DM组,HOMA-IR低于DM组;与DM组相比,NDM组治疗后胰岛素的敏感性明显改善。(4)Logistic回归显示OGTT 0.5h胰岛素与DM的缓解呈独立正相关,△HOMA-IR、△BMI与DM的缓解呈独立负相关。结论 (1)长期综合干预可使相当多的T2DM患者获得缓解。(2)控制体重、减轻胰岛素抵抗、恢复早相胰岛素分泌是DM长期缓解的重要因素。Objective To investigate the effect of long term integrated intervention on outcomes for glucose metabolism in patients with newly diagnosed type 2 diabetes mellitus（T2DM）. Methods 129 cases with newly diagnosed T2DM received an integrated intervenetion for six years. The BMI,waist to-hip ratio （WHR）, blood pressure, lipids, fasting blood glucose （FBG）, 2 hour postpradial glucose （2hPG）, HbA1c and fasting insulin （Fins） were determined. Insulin sensitivity index （ISI） and insulin resistance index（HOMA IR） were calculated. At the end of follow-up, all patients took 75gOGTT. The patients were divided into DM group and non-DM group. The nowDM included normal glucose tolerance（NGT）, impaired glucose tolerance （IGT）, impaired fasting glucose （IFG） and IGT plus IFG. Results ①Six years later,14 cases （10.9%） of 129 T2DM subjects reverted to NGT,and 27 cases （20.9%） to IGT,IFG or IGT plus IFG, but 88 eases （68.2%） remained DM. OAt baseline, the levels of FBG, WHR and triglyderides（TG） were significantly lower in nomDM group than in DM group. At the endpoint,WHR, HbA1c, FBG, 2hPG were significantly lower and HDL-C was higher in non-DM group than in DM group.After integrated intervention, the changes of BMI（△BMI） and HDL-C（△HDL-C） were significantly different between the two groups. ③At the beginning,there was no significant difference between the two groups in ISI, HOMA-IR and the insulin levels at any time point during OGTT. Six years later, the insulin levels at 30min and 60min of the OGTT were higher in non-DM group than in DM group. Compared with DM group, non-DM group had higher level of ISI and lower level of HOMA IR at the endpoint. After six years of treatment, the changes of ISI（△ISI） and HOMA-IR（△HOMA-IR） were obviously higher in non-DM group than in DM group. ④ Logistic analysis showed that the insulin concentration at 30 rain during OGTT was positively correlated with the remission of T2DM, and △HOMA-IR and △BMI after int

关 键 词：糖尿病 2型 肥胖 早相胰岛素分泌 长期缓解 

分 类 号：R587.1[医药卫生—内分泌]