三酰甘油对老年2型糖尿病患者胰岛素抵抗和胰岛细胞功能的影响  

Effect of Triglyceride on Insulin Resistance and Isletβ-cell Function in the Elderly with Type 2 Diabetes

作　　者：蒋密 韩晓玲[2] 张颖[2] Jiang Mi;Han Xiaoling;Zhang Ying(Department of Blood Transfusion,Zhongshan Hospita Affiliated to Fudan University,Shanghai,200032;Shanghai General Hospital,Shanghai Jiaotong University,Shanghai,200080 P.R.China)

机构地区：[1]复旦大学附属中山医院输血科,上海200032 [2]上海交通大学附属第一人民医院,上海200080

出　　处：《老年医学与保健》2018年第3期278-281,共4页Geriatrics & Health Care

摘　　要：目的探讨新诊断老年2型糖尿病患者的血清三酰甘油(TG)水平对胰岛素抵抗和胰岛细胞功能的影响。方法选取2014年1月—2015年12月至复旦大学附属中山医院门诊就诊的老年新诊断2型糖尿病患者228例。收集患者的一般资料、血脂,行75 g口服葡萄糖耐量试验和胰岛素释放试验,分别采用稳态模型评估细胞功能指数(HOMA-)、稳态模型评估胰岛素抵抗指数(HOMA-IR)。并将纳入的老年新诊断T2DM患者以空腹血清TG水平由低到高按四分位数分为4组:G1组[TG水平(0.41~1.24)mmol/L,=57],G2组[TG水平(1.24~1.74)mmol/L,=57],G3组[TG水平(1.77~2.21)mmol/L,n=57)],G4组[TG水平(2.25~11.5)mmol/L,=57]。4组数据比较采用方差分析,逐步多因素线性回归模型分析影响HOMA-指数的相关因素。结果与G1组相比:G2组的体重、BMI、TG和FC-P较高(P<0.05);G3组体重、BMI、TG、TC、LDL-C和FC-P较高,HDL-C和HOMA-较低(<0.05);G4组BMI、TG、TC、2 h PG、FC-P和FINS较高(P<0.05),HDL-C较低和HOMA-较低(<0.05)。与G2组相比:G3组TG和TC较高(<0.05);G4组TG、TC和FPG较高(<0.05),HDL-C和HOMA-较低(P<0.05)。逐步多因素线性回归模型显示:2 h PG[标准化回归系数(β)=-1.524、Hb A1c(β)=-3.666、体重(β)=0.475和TG(β)=-5.210]与新诊断老年2型糖尿病患者HOMA-显著相关(P<0.05)。结论随着血清TG水平升高,新诊断老年2型糖尿病患者胰岛细胞功能降低。2 h PG、Hb A1c和TG较高及体重较低是胰岛细胞功能减退的独立危险因素。Objective To discuss the effect of triglyceride（TG） on insulin resistance and islet-cell function in the elderly newly diagnozed to be with type 2 diabetes（T2 MD）. Methods 228 elderly with T2 MD newly diagnosed during the period from Jan., 2014 to Dec., 2015 were selected, their general data and lipid profiles were collected; 75 g oral glucose tolerance test（75 g OGTT） and insulin release test were performed; homeostasis model assessment for-cell function index（HOMA-） and homeostasis model assessment for insulin resistance index（HOMA-IR） were calculated respectively; the enrolled elderly were divided into 4 groups according to their fasting serum TG：G1 group [TG（0.41~1.24） mmol/L, n=57],G2 group [TG（1.24~1.74） mmol/L, n=57], G3 group [TG（1.77~2.21） mmol/L, n=57）] and G4 group [TG（2.25~11.5）mmol/L, n=57]; analysis of variance（ANOVA） was applied in the data comparison among the 4 groups and multiple stepwise linear regression model in exploring the risk factors which affected HOMA-in the elderly with T2 DM newly diagnosed. Results The elderly in G2 group had a higher weight, BMI, TG and FC-P than the elderly in G1 group（ P0.05）; the elderly in G3 group had a higher weight, BMI, TG, TC, LDL-C and FC-P but a lower HDL-C and HOMA-than the elderly in G1 group（ P0.05）; the elderly in G3 group had a higher TG and TC than the elderly in G2 group（P 0.05）; the elderly in G4 group had a higher TG, TC, FPG but a lower HDL-C and HOMA-than the elderly in G2 group（ P0.05）; the multiple stepwise linear regression analysis indicated that 2 hP G（ β=-1.524）, HbA 1 c（ β=-3.666）, weight（ β= 0.475） and TG（ β=-5.210） were closely correlated to HOMA-in the elderly with T2 MD newly diagnosed（all 0.05）. Conclusions The decrease of islet-cell function goes with the increase of serum TG level in the elderly with T2 MD newly diagnosed; higher 2 h PG, HbA 1 c, TG and lower body weight are the independent risk factors for-cell dysfunction.

关 键 词：老年 2型糖尿病 高脂血症 胰岛细胞功能 

分 类 号：R587.1[医药卫生—内分泌]