糖调节受损合并高胰岛素血症患者的胰岛功能评估及其影响因素分析  

Evaluation of Pancreatic Islet Function and Influencing Factors Analysis in Impaired Glucose Regulation Combined with Hyperinsulinemia Patients

作　　者：康怡[1] 田光[1] 张宝和[1] 徐洪涛[1] 赵宏[1] 姚合斌[1] 杜凯音[1] 连世杰 华伟[1] 胡晓东[1] 黄火高[1] 王吉[1] 

机构地区：[1]海军总医院,北京100048

出　　处：《标记免疫分析与临床》2016年第4期364-368,372,共6页Labeled Immunoassays and Clinical Medicine

基　　金：海军后勤科研项目(CHJ12L024)

摘　　要：目的评价糖调节受损合并高胰岛素血症患者的胰岛功能,分析其影响因素。方法选取北京地区中老年男性共计547例,行75g口服葡萄糖耐量(OGTT)试验,根据美国糖尿病协会(ADA)2003年标准分为三组:空腹血糖受损(IFG)325例、糖耐量减低(IGT)126例和空腹血糖受损合并糖耐量减低(IFG/IGT)96例;各组根据胰岛素测定结果再分为高胰岛素血症组(HINS)以及非高胰岛素血症组(非HINS),对比各组间的代谢特征、胰岛素抵抗和胰岛β细胞分泌功能,评估合并代谢综合征相关疾病的差异。结果 1高胰岛素血症患者IFG组和IFG/IGT组的胰岛素抵抗指数(HOMA–IR)分别是IGT组的1.42倍和1.41倍(P<0.05);非HINS人群胰岛素抵抗情况与之类似:2高胰岛素血症患者胰岛分泌功能IFG/IGT组受损最为严重,其HOMAβ细胞功能指数(HBCI)分别是IGT和IFG组的74.04%和80.98%(P<0.05);经HOMA-IR校正后,与IGT组的显著性差异更加明显,而与IFG组的差异消失;3三组糖调节受损-高胰岛素血症组合并代谢异常疾病的构成比均较相应非HINS组明显升高;IFG/IGT组合并肥胖、高血压和高脂血症的构成比最高。结论 1高胰岛素合并IFG主要的病理机制为肝脏的胰岛素抵抗;2高胰岛素血症合并IGT基础状态的胰岛分泌功能优于合并IFG者;3高胰岛素血症更易合并多种代谢紊乱,尤其是IFG/IGT患者,需要综合干预。Objective To evaluate the pancreatic islet function and analyze the influencing factors in impaired glucose regulation combined with hyperinsulinemia（ HINS） patients. Methods 547 middle-aged and elderly male cadres in Beijing were took oral glucose tolerance test,and then divided into impaired fasting glycemia（ IFG,n =325）,impaired glucose tolerance（ IGT,n = 126） and combined IFG / IGT（ n = 96） groups based on ADA2003 diagnostic criteria. Moreover,according to insulin level,each group was further divided into hyperinsulinemia（ HINS） and non-hyperinsulinemia group（ non HINS）. The metabolic characteristics,insulin resistance and isletβ cell secretory function between these groups were analyzed. The difference of combined with metabolic syndrome related diseases were evaluated. Results The HOMA-IR in hyperinsulinemia combined with IFG group and IFG / IGT group were 1. 42 and 1. 41 times higher than that of IGT group respectively（ P〈0. 05）,and the same result could be conducted with evaluation of insulin resistance in HINS group. The pancreatic islet function in hyperinsulinemia combined with IFG / IGT group impaired most severely,and the HBCI were 74. 04% and80. 98% as that of IGT and IFG group respectively（ P〈0. 05）. After corrected by HOMA-IR,the difference between IFG / IGT and IGT was more significant. However,the difference between IFG / IGT and IFG group was disappeared. The metabolic disorders constituent ratio of three IGR subtypes combined with hyperinsulinemia were significantly higher than the corresponding non-HINS subgroups. Moreover,IFG / IGT subgroup combined with highest proportions of obesity,hypertension and hyperlipidemia. Conclusion Main pathological mechanism of hyperinsulinemia combined with IFG patients lies in liver insulin resistance. The basis pancreatic islet function of hyperinsulinemia combined with IGT patient are better than those of combined with IFG.Hyperinsulinemia might be easier to combine with a variety of metabolic disorders; especially IFG /

关 键 词：糖调节受损 高胰岛素血症 胰岛素抵抗 胰岛功能 

分 类 号：R587.1[医药卫生—内分泌]