初诊断早发2型糖尿病患者胰岛素抵抗及胰岛β细胞功能分析  

Analysis of insulin resistance and pancreatic β-cell function in patients with newly diagnosed early-onset type 2 diabetes mellitus

作　　者：周琼[1] 彭葆坤[1] 周松兰[1] 梅聪 冉茜 唐哲[1] ZHOU Qiong;PENG Baokun;ZHOU Songlan;MEI Cong;RAN Xi;TANG Zhe(Department of Endocrinology,Yan′an Hospital Affiliated to Kunming Medical University,Kunming,Yunnan 650051,China)

机构地区：[1]昆明医科大学附属延安医院内分泌科,昆明650051

出　　处：《重庆医学》2022年第6期945-948,共4页Chongqing medicine

基　　金：云南省重点研发计划项目(202003AC100014)。

摘　　要：目的分析初诊断早发2型糖尿病患者的临床特点,探讨胰岛素抵抗及胰岛素分泌缺陷对早发2型糖尿病的影响。方法收集2019年1月至2021年2月在该院内分泌科住院的215例初诊断早发2型糖尿病患者作为研究组,同时收集同期经口服葡萄糖耐量试验筛查排除糖尿病者55例为对照组,收集一般资料及胰岛素、血脂水平等资料进行分析。结果研究组男性构成比、BMI、甘油三酯、总胆固醇、低密度脂蛋白、Ln[胰岛素抵抗指数(HOMA-IR)]水平高于对照组,高密度脂蛋白、Ln[胰岛素分泌指数(HOMA-β)]低于对照组,差异有统计学意义(P<0.05)。将HOMA-IR及HOMA-β标准化为Z值后进行logistic回归分析,显示HOMA-IR及HOMA-β均是早发2型糖尿病的独立影响因素,且二者存在交互作用(P<0.05)。HOMA-IR取对数进行多元线性回归分析,提示BMI是HOMA-IR的影响因素,方程为Ln(HOMA-IR)=0.325×BMI(R^(2)=0.343,P<0.05)。结论相较于胰岛素分泌缺陷,胰岛素抵抗对早发2型糖尿病的患病影响可能更大,超重和肥胖是引起胰岛素抵抗的重要危险因素。Objective To analyze the clinical characteristics of patients with initially diagnosed early-onset type 2 diabetes mellitus and to investigate the effects of insulin resistance and defective insulin secretion on early-onset type 2 diabetes mellitus.Methods A total of 215 patients with initially diagnosed early-onset type 2 diabetes mellitus who were hospitalized in the Department of Endocrinology from January 2019 to February 2021 were collected as the study group,while 55 patients who were screened out of diabetes mellitus by oral glucose tolerance test during the same period were collected as the control group,and general data and insulin and lipid data were collected for analysis.Results The male composition ratio,BMI,triglycerides,total cholesterol,low-density lipoprotein and Ln[insulin resistance index(HOMA-IR)]levels in the study group were higher than those in the control group,and high-density lipoprotein and Ln[insulin secretion index(HOMA-β)]were lower than those in the control group,with statistically significant differences(P<0.05).Logistic regression analysis after standardizing HOMA-IR and HOMA-βto Z values showed that both HOMA-IR and HOMA-βwere independent influences on early-onset type 2 diabetes,and there was an interaction between them(P<0.05).Multiple linear regression analysis with HOMA-IR taken as logarithm suggested that BMI was an influencing factor for HOMA-IR with the equation Ln(HOMA-IR)=0.325×BMI(R^(2)=0.343,P<0.05).Conclusion Insulin resistance may have a greater impact on the prevalence of early-onset type 2 diabetes compared to defective insulin secretion,and overweight and obesity are important risk factors for insulin resistance.

关 键 词：2型糖尿病 胰岛素抵抗 胰岛Β细胞功能 肥胖 早发 

分 类 号：R587.1[医药卫生—内分泌]