摘要
目的: 探讨 2型糖尿病一级亲属不同糖耐量状态下病理生理和临床特征,评估胰岛素分泌和胰岛素抵抗在 2型糖尿病发病中的作用。方法: 对 888例既往无糖耐量异常病史的 2型糖尿病患者的一级亲属进行口服75g葡萄糖耐量实验(OGTT)、糖化血红蛋白(Hba1c)和血脂测定。用胰岛素抵抗指数(HOMAIR)评估胰岛素抵抗;用胰岛β细胞功能指数 (HOMA β)评估基础胰岛素分泌;用OGTT中空腹和 30min胰岛素血糖差值的比值(ΔI30 /ΔG30)评价胰岛素早期分泌;用ΔI30 /ΔG30 /HOMAIR评估处置指数(despositionindex, DI)。结果: 888例患者的一级亲属中, 167例新诊断糖尿病, 180例空腹血糖受损或糖耐量减低 (糖调节受损 ), 457例OGTT和HbA1c均正常, 84例HbA1c高于正常而OGTT正常。从OGTT和HbA1c均正常经糖调节受损到糖尿病状态,HOMAIR、体重指数(BMI)、腰臀比(WHR)和甘油三酯(TG)进行性增加,HOMA β、ΔI30 /ΔG30、DI和高密度脂蛋白(HDL)进行性下降。根据OGTT曲线下面积三分位值,将正常糖耐量个体从低到高分为 3组 (1 /3, 2 /3, 3 /3组 ),也发现上述指标相似的变化趋势。调整了性别、年龄、BMI后,高分位 3 /3组HOMAIR高于低分位 1 /3组,而HOMA β、ΔI30 /ΔG30 /、DI低于低分位 1 /3组。结论:
Objective: To explore the pathophysiologic and clinical features and investigate the roles of insulin resistance and insulin secretion in the pathogenesis of type 2 diabetes mellitus. Methods:A total of 888 first-degree relatives without glucose intolerance history underwent an oral glucose test (OGTT) and their level of HbA1c, insulin concentration and lipid levels were determined. The homeostasis model assessment was used to estimate insulin resistance (HOMA IR ) and β-cell function (HOMA-β). The ratio of incremental glucose (ΔG30) and insulin (ΔI30) response was used to evaluate the early insulin secretion.ΔI30/ΔG30/HOMA IR was used to evaluate the glucose disposition index (DI). Results: In the subjects, 167 were diagnosed with diabetes, 180 with impaired glucose tolerance or/and impaired fasting glucose (impared glucose regulation), 457 with normal glucose tolerance and normal HbA1c, and 84 with normal glucose tolerance and high HbA1c. From normal glucose tolerance through impared glucose regulation to diabetes mellitus, the HOMA IR , body mass index (BMI), waist/hip ratio (WHR) and serum triglyceride (TG) progressively increased, HOMA-β cell 、ΔI30/ΔG30 、 DI and high density liproprotein (HDL) progressively decreased. Subjects with normal glucose tolerance were divided into three tertile subgroups (1/3, 2/3 and 3/3 groups) with different area under the curve of OGTT glucose, after being adjusted by sex, age, BMI, the 3/3 group was found having higher HOMA IR , and lower HOMA-β, ΔI30/ΔG30/, and DI than the 1/3 group. Conclusion: Both insulin resistance and impaired β cell function are important pathophysiologic changes contributing to the onset and development of type 2 diabetes. These changes and lipid profile have occurred before a patient is diagnosed with abnormal glucose tolerance.
出处
《北京大学学报（医学版）》
CAS
CSCD
北大核心
2005年第2期159-162,共4页
Journal of Peking University:Health Sciences
