2型糖尿病家系一级亲属的胰岛β细胞功能与胰岛素抵抗的相关性

A study of insulin secretion function and insulin resistance in the first degree relatives of type 2 diabetic families

目的 了解 2型糖尿病 (T2DM )家系中 β细胞功能减退和胰岛素抵抗 (IR)的情况。 方法 收集 2 3个T2DM家系一级成年亲属共 2 18人 ,其中糖耐量正常 (NGT)者 12 8例 (A组 ) ;糖耐量受损 (IGT)者 2 3例 (B组 ) ;T2DM患者 5 1例 (C组 ) ;新诊断T2DM患者 16例 (D组 )。无糖尿病家族史且口服 75 g葡萄糖耐量试验 (OGTT)正常者 5 9名为对照 (E组 )。对所有受试者进行OGTT、胰岛素 (包括真胰岛素 )释放试验和血脂测定等项目。 结果 A、B组血低密度脂蛋白 (LDL C)水平高于E组 ,C、D两组血LDL C、甘油三酯 (TG)和胆固醇 (TC)水平高于E组。A、B和D组OGTT各时段 ( 30min除外 )免疫胰岛素水平分别高于E组 ;B、C和D组有免疫胰岛素分泌高峰延迟。A组OGTT后 30min真胰岛素水平低于E组 ;B组OGTT 0min和 30min真胰岛素水平低于E组 ;C和D两组OGTT各时段真胰岛素均低于E组 ;B、C和D组胰岛素敏感性指数低于E组 ,A、B、C和D组胰岛素抵抗指数 (HOMA IR)高于E组。 结论 T2DM家系非糖尿病同胞有血脂代谢异常和IR ,IGT患者既有IR又有 β细胞功能减退 ;新诊断的和以往诊断的糖尿病患者均有明显β细胞功能减退。

Objective To study effects of beta cell dysfunction and insulin resistance on the pathogenesis of type 2 diabetic families. Methods Oral glucose tolerance test (OGTT), insulin and true insulin secretion test, as well as the assays of blood triglyceride (Tg), cholesterol (Ch), low density lipoproteins (LDL C) and high density lipoproteins (HDL C) were performed in a total of 218 adult subjects (over 20 years of age) from 23 type 2 diabetic families. The study was consisted of 128 non diabetic first degree relatives (group A), 23 patients with impaired glucose tolerance (group B), 51 diabetic patients diagnosed previously (group C), and 16 diabetic patients diagnosed newly (group D) ,and 59 healthy subjects without diabetic families and with normal OGTT (group E). Results Levels of serum LDL C in Group A and B were higher than that in group E, levels of serum LDL C, TG and TC in group C and D were higher than that in group E. Each level(except 30 min )of immunoreactive insulin at OGTT in group A,B and D was higher than that in group E. Secreting peak times in groups A and E were at 60 min of OGTT, but those in group B, C and D were all at 120 min. The true insulin levels at fasting and 30 min in the OGTT(only 30 min at OGTT in group A)in group A and B were lower than that in group E. Each level of true insulin at OGTT in group C and D was lower than that in group E.IR indexes in group A, B, C and D were all higher than that in group E. HOMA β in group B,C and D were all lower than that in group E. Conclusions There is metabolic abnormality of blood lipid, and insulin resistance in non diabetic first degree relatives of type 2 diabetic families. There is both insulin resistance and islet secretion dysfunction in patients with impaired glucose tolerance. There is critical islet dysfunction in previously and newly diagnosed diabetic patients.