成人糖尿病发生模式的探讨  

Model of development of diabetes mellitus in adult Chinese

作　　者：李光伟[1] 王金平[2] 陈川[1] 杨文英[1] 姜亚云[2] 胡泽溪[2] 胡英华[2] 潘孝仁[1] 

机构地区：[1]中日友好医院内分泌科,北京100029 [2]大庆市第一医院心血管病研究室

出　　处：《中华医学杂志》2001年第15期914-917,共4页National Medical Journal of China

摘　　要：目的　探讨我国成年人糖尿病的发病模式和胰岛素抵抗及 β细胞胰岛素分泌功能损害在发病中的作用。方法　对以标准葡萄糖耐量试验筛查诊断的糖耐量减低 (IGT) 30 7例和糖耐量正常 (NGT) 12 6例 (年龄 2 5～ 74岁 )进行 6年随访 ,初访时测定口服糖耐量试验 (OGTT) 0、6 0、12 0min之血糖及血浆胰岛素浓度。每 2年重复做OGTT ,空腹血糖≥ 7.8mmol/L及 /或OGTT试验 2h血糖≥11.1mmol/L诊为糖尿病。以t检验、χ2 检验及多因素回归分析胰岛素抵抗及 β细胞功能对糖尿病发病率的影响。结果　 6年随访中发展为糖尿病的IGT有约 70 %来自胰岛素抵抗人群 ,另有约 30 %糖尿病患者在其IGT阶段并无明显胰岛素抵抗。多因素回归分析结果显示 ,IGT组基线胰岛素敏感性及胰岛素分泌功能与随访发生糖尿病者呈显著负相关 (OR值为 0 .41及 0 .39,P <0 .0 1)。在NGT人群中 ,胰岛素抵抗亚组 6年后糖耐量恶化率远高于非胰岛素抵抗组 (34 .5 %比 13.4% ,P <0 .0 5 ) ,多因素逐步回归分析结果仅胰岛素抵抗与糖耐量恶化呈显著正相关 (P =0 .0 1)。结论　我国大部分成人糖尿病发病呈 2个阶段模式 :第一阶段从NGT发展为IGT ,在此阶段胰岛素抵抗起主要作用 ;第二阶段从IGT发展为糖尿病 ,在此阶段胰岛素抵抗和Objective To explore the model for development of non-insulin depe n dent diabetes and the roles of insulin resistance and insulin secretion impairme nt in the initiation of diabetes in adult Chinese. Methods 432 non-diabetics a g ed 24～74, 126 with normal glucose tolerance (NGT) and 307 with impaired glucose tolerance (IGT), were selected by standard oral glucose tolerance test (OGTT) an d plasma insulin concentration measurement in Daqing, Heilongjiang Province, in 1986, and then followed up for six years. OGTT was conducted every two years. Th e subjects with fasting plasma glucose (FPG)≥7.8 mmol/L and/or two hour plasma glucose (PG2h)≥11.1 mmol/L were diagnosed as with diabetes. The effect of in sulin resistance and insulin secretion at baselie on worsening of glucose tolera nce in both NGT and IGT groups were analyzed using SAS software. Results 70% of DM cases d eveloped from the insulin-resistant IGT subgroup at the end of the study. About 30% of DM cases were not insulin-resistant in their IGT stage. Proportional haz a rd analysis showed that the baseline PG2h and BMI significantly positively corre lated to the development of diabetes during the six years follow-up period (RR =1.35 and 1.32 respectively, P <0.01). Dietary and exercise intervention sign ific antly decreased such risk. With these confounders being controlled, baseline ins ulin sensitivity and insulin secretion index significantly negatively correlated to the development of diabetes in the IGT group (RR=0.41 and 0.39 respectively , P <0.01). Incidence of IGT (or DM) in the insulin resistant NGT subgroup wa s mu ch higher than that in the non-insulin resistant NGT subgroup (34.5% vs 13.4%, P <0.05), stepwise logistic regression analysis showed that only the baseline insu lin sensitivity entered the model and negatively associated to the risk of worse ning of glucose tolerance ( P <0.05). Conclusion A two-step model of development o f diabetes mellitus is shown among most adult Chinese diabetics. In the first

关 键 词：糖尿病 非胰岛素依赖型 胰岛素抵抗 DM 胰岛素敏感性 糖耐量 

分 类 号：R587.1[医药卫生—内分泌]