糖耐量受损和新诊断2型糖尿病人群胰岛素分泌功能的研究

糖耐量受损和新诊断2型糖尿病人群胰

岛素分泌功能的研究

(作者：__________ 单位：___________ 邮编：___________ )

作者：袁国跃，周丽斌陈名道

【摘要】目的：研究葡萄糖耐量受损(IGT)、新诊断的2型糖尿病

人群1相胰岛素分泌功能。方法：选择正常健康人28例、IGT者31例、新诊断的2型糖尿病患者31例，均行口服75 g葡萄糖耐量试验和减少样本数的Bergman微小模型技术结合静脉葡萄糖耐量试验(FSIGTT)，分别用胰岛B细胞功能指数(HBCI) , △ I30/ △ G30及急性胰岛素反应(AIR)评估胰岛B细胞功能，AIR用减少样本数的Bergman 微小模型技术结合FSIGTT检测;同时测定受试者的体质量指数(BMI) 和腰臀比(WHR)检测空腹状态下血脂、血糖、胰岛素、糖化血红蛋白(HbA1c)等生化指标。结果：(1) 2型糖尿病组的AIR[27.4(-2.5〜76.5)mU/L]显著低于正常组(270.5 士128.3) mU/L 及IGT 组(213.3 士

154.4)mU/L(P0.01)，正常组与IGT组之间无显著差异。(2) 2 型糖尿病组的厶I30/ △ G30(1.1 士0.6),HBCI(3.8 士 1.0)显著低于正常组(分别为 2.7 士0.9，4.2 士 1.0)及IGT 组(分别为 2.5 士 1.0，4.9 士

1.7)(P0.01)，而后两组间△ I30/ △ G30,HBCI均无显著差异。(3) AIR

与 A 130/ △ G30,HBCI,胰岛素,BMI显著正相关(P0.05〜P0.01)，与血糖、年龄、HbAlc胰岛素敏感指数(SI)显著负相关(P0.05〜P0.01)。在校正年龄、BMI 后，与 A I30/ A G30,HBC、胰岛素(30,60,120,180 min)仍显著正相关，与各时间点血糖,HbA1c显著负相关。⑷ 以AIR 为应变量，其他变量为自变量作多元逐步回归，有BMI, A I30/ A G30 进入最后的方程(r2=0.656, P0.01)。结论：新诊断的2型糖尿病人群AIR 显著降低，而HBC、特别是A I30/ A G30与AIR有着很好的相关性，是用来评估新诊断的2型糖尿病人群胰岛素分泌功能的较为简易的方法。【关键词】糖耐量受损；2型糖尿病；急性胰岛素反应

[Abstract] Objective: To study first 拟phase insulin secretion in subjects with impaired glucose tolerance(IGT) and newly diagnosed type 2 diabetes mellitus(DM).Methods : A total of 90 subjects[twe nty 拟eight no rmal con trol(NC) subjects, 31 patients with impaired glucose tolerance(IGT), and 31 patients with n ewly diag no sed type 2 diabetes mellitus(DM)] un derwe nt 75g oral glucose toleranee test and insulin 拟modified reduced sample number(n=12) of Bergman ' s minimal model method with freque ntly sampled in trave nous glucose tolera nee test(FSIGTT)」nsulin secretion was determined by Homa [3

拟cell function index(HBCI), A I30/ A G30 and acute insulin

resp on se(AIR)to glucose, respectively.Mea nwhile the anthropometrical parameters including body massindex(BMI) and

waist hip ratio(WHR) were evaluated and the serum lipid profile, plasma glucose , insulin and HbA1c levels were also measured. Results : (1) The AIR in DM group[27.4(-2.5-76.5) mU/L]was

sig nifica ntly lower tha n that in NC(270.5 士 128.3 mU/L) and IGT[213.3 士154.4 mU/L]groups(P0.01), and there was no

sig ni fica nt differe nee betwee n IGT and NC groups.(2) The △I30/ △ G30(1.1士0.6) and HBCI(3.8 士1.0) in DM group were

sig ni fica ntly lower than that in NC(2.7 士0.9 , 4.2 士1.0, respectively.)and IGT(2.5 士1.0 , 4.9 士1.7, respectively.) groups(P0.01),and there was no significant differenee between IGT and NC groups.(3) As to AIR level, it was positively

correlated with△ I30/ △ G30, HBCI, insulin and BMI.(P0.05 〜0.01), and negatively correlated with glucose,age, HbA1c and insulin sensitivity index(SI)(P0.05 〜P0.01).After adjustment

for BMI and age, △ I30/ △ G30, HBCI and insulin remained positively correlated with AIR.Glucose and HbA1c remained n egatively correlated with AIR .(4) In gen eral multivariate regression, BMI and △ I30/ △ G30 were significantly

in depe nde nt determi nants for AIR(r2=0.656, P0.01). Conclusion : The AIR decreased in newly diagnosed type 2 DM group, and was positively correlated with HBCI, especially with △ 130/ △