高胰岛素血症与正常胰岛素血症糖耐量低减人群转归差异的探讨  被引量:7

Different prevalence of impaired glucose tolerance between hyperinsulinemic and normoinsulinemic subjects

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作  者:肖靖[1] 田慧[1] 李春霖[1] 钟雯雯[1] 孙般若[1] 李昱芃[1] 方福生[1] 韩晓菲[1] 刘永泉[1] 成晓玲[1] 

机构地区:[1]解放军总医院老年内分泌科,北京100853

出  处:《中华内科杂志》2012年第4期299-303,共5页Chinese Journal of Internal Medicine

基  金:全军医药卫生科研基金课题(06MA273)

摘  要:目的通过对中老年人群不同糖代谢状态进行调查分析,研究不同胰岛素水平对于糖耐量低减(IGT)患者向2型糖尿病(T2DM)转变的影响。方法研究对象为2005-2007年在解放军总医院体检的北京居民,并根据口服葡萄糖耐量试验(OGTT)结果将人群分为正常糖耐量-非高胰岛素血症(NGT—NHIns)、糖耐量低减-高胰岛素血症(IGT-HIns)、糖耐量低减-非高胰岛素血症(IGT-NHIns)3组,以2009-2010年随访作为结点观察3组人群的转归情况。高胰岛素血症以空腹胰岛素≥15mU/L和(或)糖负荷后2h胰岛素水平≥80mU/L作为诊断标准。结果IGT—NHIns组转变成T2DM的比例(42/133)较IGT—HIns(24/154)、NGT—NHIns(12/126)组要高。IGT—NHIns组稳态模型评估的胰岛素抵抗指数(HOMA—IR)比IGT—HIns组低[0.96(0.40,3.53)比2.04(0.59,23.20),P〈0.05],但是全身胰岛素敏感性指数(WBISI)却要高于IGT—HIns组[7.48(3.20,31.35)比3.28(0.86,7.67),P〈0.05];在评价B细胞功能方面,IGT—NHIns组新β细胞功能指数(MBCI)和胰岛素分泌指数(ISI)分别比IGT.HIns组差得多[2.57(0.58,10.98)比5.17(1.04,65.09);7.66(0.99,28.40)比17.56(4.18,96.46),P值均〈0.01]。结论IGT—NHIns状态者发展到T2DM的风险高于IGT—HIns。预防IGT向糖尿病的转变,除了关注高胰岛素血症的危险外,对于胰岛素水平正常的IGT人群更应引起重视,早期加强危险因素控制有利于保护β细胞功能,延缓向糖尿病发展的进程。Objective To study the impact of different insulin levels on the conversion from impaired glucose tolerance (IGT) to type 2 diabetes mellitus (T2DM), through analysis of different glycometabolism condition among quiuquagenarian population. Methods Subjects enrolled were Beijing habitants who received annual physical examination [ including oral glucose tolerance test (OGTT) ] in the Chinese PLA General Hospital from 2005-2007. According to the OGTT results, the subjects were divided into three groups, including normal glucose toleranee-non-hyperinsulinemia group (NGT-NHIns), IGT- hyperinsulinemia group ( IGT-HIns ) and IGT-non-hyperinsulinemia group ( IGT-NHINS ). The prognosis between the year 2009 and 2010 of the three groups was observed. Hyperinsulinemia was diagnosed with fasting serum insulin i〉 15 mU/L and/or 2-hour serum insulin ≥ 80 mU/L after glucose loading. Results The rate of case number of conversion to T2DM in IGT-NHIns group (42/133) was higher than that in IGT-HIns group (24/154) or NGT-NHIns group (12/126). The HOMA insulin resistance index (HOMA- IR) of individuals with IGT-NHIns was lower than that of IGT-HIns [0. 96(0. 40,3.53) vs 2. 04 (0. 59, 23.20), P 〈 0. 05 ] , while whole body insulin sensitivity index (WBISI) was higher than that of IGT-HIns [ 7.48 (3.20,31.35 ) vs 3.28 ( 0. 86,7.67 ), P 〈 0. 05 1. Modified [3-cell function index (MBCI) and insulin secretion index (ISI) in IGT-NHIns was poorer than that of IGT-Hlns respectively [ 2. 57 (0. 58 ,10. 98) vs 5.17 (1.04,65.09) ; 7.66 (0. 99,28.40) vs 17.56 (4. 18,96.46 ), all P values 〈 0. 01 1. Conclusions The risk of IGT-NHIns progressing into T2DM is higher than that of IGT-Hlns. For the prevention of T2DM, individuals with IGT-NHIns should be paid more attention than keeping an eye on IGT-Hlns patients. Early control of risk factors could protect β cell function and prevent the progression to T2DM.

关 键 词:高胰岛素血症 预后 糖耐量低减 Β细胞功能 

分 类 号:R587.1[医药卫生—内分泌]

 

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