血糖正常人群的胰岛素分泌及敏感性与2型糖尿病遗传背景遗传强度的相关性研究  

A cross-section study of the relation of genetic background and genetic intensity of type 2 diabetes to insulin secretion and sensitivity in people with normal blood glucose

作　　者：陆晓敏[1] 闾倩[1] 宋艳[1] 陈娟[1] 廖小娴 李拓[1] 石勇铨[1] 

机构地区：[1]第二军医大学附属长征医院内分泌科,上海200003

出　　处：《中国实用内科杂志》2017年第5期456-459,共4页Chinese Journal of Practical Internal Medicine

基　　金：上海市卫生与计划生育委员会公共卫生3年行动计划重点项目

摘　　要：目的评估上海居民糖代谢状况,观察2型糖尿病家族史人群不同遗传背景、遗传强度下的胰岛素分泌和胰岛素敏感性特点。方法对2016年12月至2017年2月上海多个社区血糖正常的居民进行流行病学调查问卷、体格检查以及口服葡萄糖耐量试验(OGTT),测定静脉血糖、胰岛素水平,根据稳态模型法(HOMA)及胰岛素敏感性指数(Gutt-ISI)评估胰岛素分泌及敏感性。结果 (1)292例上海市居民中2型糖尿病发生率为6.51%(19例)、空腹血糖受损(IFG)及糖耐量异常(IGT)发生率为12.67%(37例)。(2)2型糖尿病家族史阳性的男性及女性人群,其胰岛素敏感性较无家族史人群降低(HOMA-IS:男性0.52±0.17对0.54±0.28,女性0.59±0.30对0.69±0.33,P=0.04),胰岛B细胞分泌功能较无家族史人群升高显著(HOMA-β:男性190.6±130.31对142.58±76.06,女性157.84±96.68对120.87±74.71,P=0.02)。(3)在同胞2型糖尿病遗传背景人群的胰岛素敏感性及胰岛B细胞分泌功能较其他父系、母系、双系等遗传背景者改变具有统计学差异(P<0.05),且胰岛素敏感性减退与糖尿病遗传背景呈负相关,HOMA-β水平呈正相关(P<0.05)。结论有2型糖尿病家族史人群其在早期血糖正常时,即出现胰岛素敏感性下降,以同胞遗传背景为著,且胰岛素敏感性减退程度随遗传强度增加而递减,胰岛B细胞通过代偿性分泌以维持其血糖正常。Objective To evaluate the glucose tolerance status of residents in Shanghai and the effects of different genetic background and intensity on insulin secretion and insulin resistance in subjects with family history of type 2 diabetes（T2DM）. Methods Epidemiological questionnaires, physical examination and OGTT were performed in residents in many communities in Shanghai. Homeostasis model and Gutt-ISI were calculated by the level of blood glucose and insulin to assess the insulin secretion and sensitivity in the community with normal blood glucose in many communities in Shanghai. Results （1） The incidence of T2DM was 6.51% （19 cases）, impaired fasting glucose （IFG） and impaired glucose tolerance （IGT） was 12.67% （37 cases） at all in the 292 subjects. （2） As the SNK and t test analysis showed, the average numbers of Insulin sensitivity was worse in subjects with positive family history of T2DM than those without family history （HOMA-IS： male 0.52＋0.17 vs. 0.54＋0.28, female 0.59＋0.30 vs. 0.69＋0.33, P=0.04）, the mean level of secretion function of islet B cells was significantly higher than that without family history （HOMA-β： male 190.6＋ 130.31 vs. 142.58＋76.06, female 157.84＋96.68 vs. 120.87＋74.71, P=0.02）. （3） There were significant differences both in the insulin sensitivity and B cell secretory function in the subjects with siblings of T2DM than those with paternal inheritance, maternal inheritance and parental inheritance （P〈0.05）. Meanwhile, the insulin sensitivity was declined with the severity of genetic background of T2DM, and the level of HOMA-β was positively correlated with the genetic background （P〈0.05）. Conclusion Subjects with family history of T2DM has an obvious decrease of insulin sensitivity in the early stage of normal blood glucose specially with siblings of T2DM. The candidates＇ insulin sensitivities decreased with the worse of genetic intensity. Therefore, the islet B cells, in order to maintain the normal blood glucose

关 键 词：2型糖尿病 胰岛B细胞功能 胰岛素敏感性 

分 类 号：R587.1[医药卫生—内分泌]