中国糖尿病持续攀升新解:中年肥胖相关胰岛素抵抗成为主要威胁  

New insights into the growing diabetes epidemic in China:middle-aged obesity-related insulin resistance becomes the major threat

作　　者：王天歌[1] 陆洁莉[1] 毕宇芳[1] 王卫庆[1] 宁光[1] Wang Tiange;Lu Jieli;Bi Yufang;Wang Weiqing;Ning Guang(National Clinical Research Center for Endocrine and Metabolic Diseases,Shanghai Institute of Endocrine and Metabolic Diseases,Department of Endocrine and Metabolic Diseases,Ruijin Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200025,China)

机构地区：[1]国家代谢性疾病临床医学研究中心,上海市内分泌代谢病研究所,上海交通大学医学院附属瑞金医院内分泌代谢病科,200025

出　　处：《中华内分泌代谢杂志》2020年第3期198-200,共3页Chinese Journal of Endocrinology and Metabolism

基　　金：国家自然科学基金(81730023、81930021、81970691、81970706、81970728)。

摘　　要：为有效防治中国糖尿病,亟待找到近年来糖尿病持续攀升的根本原因。2型糖尿病的主要病理特征是胰岛素抵抗和β细胞功能障碍。既往研究表明,以中国人和日本人为代表的东亚人2型糖尿病的发病机制主要为β细胞功能障碍,而美国人2型糖尿病的发病机制主要是胰岛素抵抗,且肥胖是这两类人群糖尿病病因差异的主要原因。中国糖尿病近40年急剧增加,β细胞功能障碍显然已不足以成为解释该流行趋势的主要原因。过去40年间,中国见证了从高体力活动/低热量低脂饮食向久坐生活方式/高能量高脂饮食的转变,与此同时,肥胖与2型糖尿病患病率呈平行上升趋势。肥胖是否影响中国糖尿病,是关系到解释中国糖尿病流行特点,探究中国糖尿病病因特征,以及制定行之有效的糖尿病防控策略的关键问题。Lancet Diabetes&Endocrinology近期发表的一项中国心脏代谢疾病和癌症队列研究(China Cardiometabolic Disease and Cancer Cohort Study,4C),分析了胰岛素抵抗、β细胞功能障碍及二者的交互作用对2型糖尿病发生风险的作用,并揭示了肥胖对糖尿病病因的影响。Delineation of the relationship between insulin resistance,βcell dysfunction,and obesity is crucial for the prevention and effective management of diabetes.Previous studies have indicated that,compared with type 2 diabetes in Caucasian,type 2 diabetes in East Asians is characterized primarily byβcell dysfunction rather than insulin resistance.This pathophysiological characterization of diabetes in East Asians is mainly derived from Japanese and Asian-American populations,whereas data from China's Mainland are scarce.Over the past four decades,China has witnessed a substantial rise in obesity,in parallel with the transitions from principally active lifestyles and calorie-restricted diets to sedentary life styles and energy-dense,western diets.Obesity is an insulin resistance state and the major factor driving the worldwide epidemic of diabetes.It is unknown whether,and if so how,obesity affects the two primary mechanisms,insulin resistance andβcell dysfunction,responsible for the development of diabetes in the Chinese population.Recently,the Lancet Diabetes&Endocrinology published an original research paper from the China Cardiometabolic Disease and Cancer Cohort Study(4C).From a public health perspective,the results of this study reinforce the urgency of tackling obesity as a major preventive strategy for the epidemic of type 2 diabetes in China.

关 键 词：糖尿病 胰岛素抵抗 胰岛Β细胞功能障碍 肥胖 中国 

分 类 号：R587[医药卫生—内分泌] R589[医药卫生—内科学]