不同糖耐量人群胰岛素抵抗和胰岛β细胞功能的比较研究  

Comparative study of insulin resistance and pancreatic β-cell function in different glucose tolerance subjects

作　　者：杨明[1,2] 张敏 周广朋[1] 贾晓利[1] 龙建竹[2] 王钧慷[2] 任敏[1] 陈平[1] 陈树[1] 

机构地区：[1]四川省医学科学院.四川省人民医院老年内分泌科,四川成都610072 [2]遵义医学院,在读硕士研究生贵州遵义563003

出　　处：《实用医院临床杂志》2012年第3期47-51,共5页Practical Journal of Clinical Medicine

基　　金：四川省卫生厅科研基金资助项目(编号:070044)

摘　　要：目的观察不同糖耐量人群胰岛素抵抗(Insulin Resistance,IR)和胰岛β细胞功能改变的特点,为临床正确选择干预病变的靶点和治疗措施提供依据。方法对9922例初诊或疑诊为2型糖尿病(T2DM)患者的口服75 g葡萄糖耐量试验(Oral Glucose Tolerance Test,OGTT)及胰岛素释放结果进行分析。根据空腹血糖(FBG)6.1 mmol/L和7.0 mmol/L及餐后2 h血糖(2 hPG)7.8 mmol/L和11.1 mmol/L四个切点将人群分为正常糖耐量组1362例(NGT组)、单纯空腹血糖受损组982例(I-IFG组)、单纯糖耐量减低组778例(I-IGT组)、联合糖耐量减低组1300例(C-IGT组)、空腹正常型糖尿病组250例(NFD组)、空腹受损型糖尿病组1186例(IFD组)、餐后正常型糖尿病组14例(NPD组)、餐后受损型糖尿病组332例(IPD组)、空腹合并餐后型糖尿病组3708例(CFPD组)。结果①稳态模型胰岛素抵抗指数(HOMA-IR)由小到大依次为NGT组、I-IGT组、NFD组、I-IFG组、C-IGT组、IFD组、IPD组、CFPD组,组间比较差异有统计学意义(P<0.05);NPD组与NGT组、I-IGT组、C-IGT组比较差异有统计学意义(P<0.05),与其他组差异无统计学意义。②胰岛素分泌指数(ΔI30/ΔG30)由小到大依次为CFPD组、IFD组、NFD组、IPD组、C-IGT组、NPD组、I-IGT组、I-IFG组、NGT组,各组间比较差异有统计学意义(P<0.05)。③校正IR影响后,胰岛β细胞分泌功能由弱到强依次为CFPD组、IPD组、IFD组、NPD组、NFD组、C-IGT组、I-IFG组、I-IGT组、NGT组,各组间比较差异有统计学意义(P<0.05)。结论不同糖耐量人群IR和胰岛β细胞功能具有FBG越高基础胰岛素抵抗越严重,单纯以餐后增高为特征的糖尿病患者并未表现出基础胰岛素抵抗,主要是早晚相胰岛素分泌缺陷,空腹相当时餐后血糖越高胰岛分泌功能越弱,即随着空腹、餐后糖代谢紊乱的不断进展,IR逐渐加重,胰岛β细胞分泌功能进行性减退。针对此特点进行个体化干预及治疗尤为重要。Objective To explore the features of pancreatic β-cell function and insulin resistance in different glucose tolerance subjects and provide theoretical basis for the clinical prevention and treatment of diabetes. Methods We analyzed the results of the 75 g oral glucose tolerance test（OGTT） and the insulin release test for 9922 patients who were initially suspected or diagnosed with diabetes mellitus.Taking fasting plasma glucose 6.0 mmol/L,fasting plasma glucose 7.0 mmol/L,2 h postprandial blood glucose 7.8 mmol/L and 2 h postprandial blood glucose 11.1 mmol/L as four dividing points,the patients were divided into 9 groups,the normal glucose tolerance group with 1362 cases（NGT Group）,the isolated impaired fasting glucose group with 982 cases（I-IFG Group）,the isolated impaired fasting glucose group with 778 cases（I-IGT Group）,the combined impaired glucose tolerance group with 1300 cases（C-IGT Group）,the normal fasting diabetes group with 250 cases（NFD Group）,the impaired fasting diabetic group with 1186 cases（IFD Group）,the normal postprandial diabetes group with 14 patients（NPD Group）,the impaired postprandial diabetes group with 332 cases（IPD Group）,and the combined fasting with postprandial diabetes group with 3708 cases（CFPD Group）. Results Homeostasis model assessment of insulin resistance（HOMA-IR） among groups illustrated in ascending order as follows：NGT Group,I-IGT Group,NFD Group,I-IFG Group,C-IGT Group,IFD Group,IPD Group,and CFPD Group.There was significant difference between each two groups（P 0.05）.NPD Group was significantly different from NGT Group,I-IGT Group,and C-IGT Group（P 0.05）,while not from other groups.ΔI30/ΔG30 among groups illustrated in ascending order as follows：CFPD Group,NFD Group and IFD Group,IPD Group,C-IGT Group,I-IFG Group,I-IGT Group and NPD Group,and NGT Group.There was significant difference between each two groups（P 0.05）.After corrected the influence of insulin resistance,the β-cell function among groups illustrat

关 键 词：胰岛Β细胞功能 胰岛素抵抗 糖耐量 糖尿病 

分 类 号：R587.1[医药卫生—内分泌] R322.57[医药卫生—内科学]