2型糖尿病患者肥胖与黎明现象的相关性研究  

Correlation study between obesity and dawn phenomenon in patients with type 2 diabetes

作　　者：郭振红[1] 许杰[1] 王靖宇[1] 韩菲[1] 张祎[1] 杨笑云 杨少华[1] 常柏[1] 杨菊红[1] 单春艳[1] 陈莉明[1] 常宝成[1] 徐延光[1] 

机构地区：[1]天津医科大学代谢病医院糖尿病肾病科卫生部激素与发育重点实验室,300070

出　　处：《中华内科杂志》2016年第1期16-20,共5页Chinese Journal of Internal Medicine

基　　金：国家自然科学基金（81373864、81273914、81200612）;天津市自然科学基金（14JCYBJC26200）

摘　　要：目的 探讨2型糖尿病患者黎明现象发生率与肥胖有无相关性.方法 筛选2011年3月至2014年10月在天津医科大学代谢病医院住院的2型糖尿病患者98例,根据BMI将患者分为体重正常组：BMI 18.5 ～23.9 kg/m2（30例）;超重组：BMI 24.0～27.9 kg/m2（33例）;肥胖组：BMI≥28.0 kg/m2（35例）.3组患者均行连续72h动态血糖监测及空腹胰岛素、C肽等测定.比较不同BMI患者黎明现象发生率,并对其相关指标进行相关性分析.结果 2型糖尿病患者随BMI的增加,黎明现象发生率亦逐渐增加,体重正常组、超重组及肥胖组分别为33.3％、78.8％、88.6％（P＜0.05）.Spearman相关系数分析显示,黎明现象与BMI（r =0.424,P＜0.05）、稳态模型胰岛素抵抗指数（HOMA-IR）（r=0.781,P＜0.05）、腰围（r=0.394,P＜0.05）、空腹C肽（r=0.254,P＜0.05）、TG（r =0.220,P＜0.05）呈正相关;与病程（r=-0.278,P=0.006）、HDL-C（r=-0.268,P=0.008）呈负相关;但与年龄（r=-0.125）、LDL-C（r=0.040）、糖化血红蛋白（r=0.126）、TC （r=0.051）及空腹血糖（r=0.168）相关性不显著（P值均＞0.05）.结论 黎明现象是导致2型糖尿病患者空腹高血糖的常见原因之一,随着BMI的增加,黎明现象发生率也明显增加,其发生与肥胖、胰岛素抵抗密切相关.Objective To investigate the correlation between the frequency of dawn phenomenon and obesity in patients with type 2 diabetes.Methods This study was conducted in 98 patients with type 2 diabetes admitted to the Metabolic Disease Hospital of Tianjin Medical University from 2011 to 2014.The subjects were divided into 3 groups according to BMI： the normal weight （BMI 18.5-23.9 kg/m2, n =30）, the overweight（BMI 24-27.9 kg/m2, n =33） and the obesity （BMI ≥28.0 kg/m2, n =35）.All participants underwent continuous glucose monitoring for 72 h.Fasting plasma glucose（FPG）, insulin and C-peptide were tested.Frequency of dawn phenomenon among the 3 groups was calculated, and the correlations between dawn phenomenon and its related factors were analyzed.Results The frequency of dawn phenomenon in type 2 diabetes increased with the increase of BMI in the 3 groups （P 〈 0.05） with 33.3% in the normal weight, 78.8% in the overweight and 88.6% in the obesity groups, respectively.The dawn phenomenon was positively correlated with BMI （r =0.424, P 〈 0.05）, Homeostasis model assessment of insulin resistance（HOMA-IR） （r =0.781 , P 〈 0.05） , waist circumference （r =0.394, P 〈 0.05）, fasting C-peptide（r =0.254, P〈0.05）and TG （r =0.220, P 〈0.05）.It was negatively correlated with the course of diabetes mellitus （r =-0.278, P 〈 0.05） and HDL-C （r =-0.268, P 〈 0.05）.No correlation could be viewed between the dawn phenomenon and age, LDL-C, glycosylated hemoglobin A1 c （HbA1 c） , TC and FPG （P 〉 0.05）.Conclusions The dawn phenomenon is closely associated with obesity and insulin resistance.The frequency of dawn phenomenon increases with BMI.

关 键 词：糖尿病 2型 黎明现象 体重指数 腰围 

分 类 号：R587.1[医药卫生—内分泌]