不同糖代谢状态人群胰岛素抵抗和胰岛β细胞功能研究

Insulin resistance and function of islet β cell in Chinese with different status of glucose metabolism

目的 探讨从正常糖耐量到糖尿病 (DM )不同糖代谢水平 ,胰岛素抵抗 (IR)与胰岛 β细胞功能的演变。方法 青岛市区 3 0～ 74岁的正常糖耐量 (NGT ) 44 7例 ;空腹血糖受损 (IFG) 14 2例 ;糖耐量受损 (IGT) 93例 ;IFG合并IGT(IFG +IGT) 42例 ;新诊DM 15 3例。采用HOMA IR评价IR ,HOMA β、ΔI3 0 /ΔG3 0 分别评价基础状态下及糖负荷后的早期胰岛 β细胞功能。 结果 IFG组HOMA IR为 1.14± 0 .0 6,明显高于NGT组的 0 .93± 0 .0 3 (P <0 .0 5 ) ,IFG组HOMA β为 4.5 3± 0 .0 6,低于NGT组 5 .10± 0 .0 4(P<0 .0 5 ) ,两组间△I3 0 /△G3 0 差异无显著性 ( 4 .86± 0 .11vs 4.99± 0 .11) ;IGT组HOMA IR为 1.12± 0 .0 7,明显高于NGT (P <0 .0 5 ) ,两组间HOMA β差异无显著性 ,IGT组△I3 0 /△G3 0 为 4.62± 0 .14 ,低于NGT组的 4.99± 0 .11(P <0 .0 5 ) ;DM组HOMA IR为 1.5 5± 0 .0 5 ,明显高于NGT、IGT和IFG组 (P <0 .0 5 ) ,DM组HOMA β和△I3 0 /△G3 0 分别为 3 .94± 0 .0 6、3 .93± 0 .12 ,明显低于其他各组 (P <0 .0 5 ) ,DM组基础与糖负荷后的胰岛 β细胞功能均明显受损。 结论 IFG患者主要表现 β细胞功能缺陷 ,IGT为胰岛素早期分泌受损 ,DM患者兼有严重的IR和β细胞缺陷。从NGT到DM ,?

Objective To investigate the changes of insulin resistance (IR) and function of islet β cell in Chinese with different status of glucose metabolism. Methods Isolated impaired fasting glucose (IFG, n=142), isolated impaired glucose tolerance (IGT, n=93), combined IFG and IGT (IFG+IGT, n=42), newly diagnosed diabetes (DM, n=153) were studied. Subjects of normal glucose tolerance (NGT, n=447) were randomly selected from residents living in the same community of the patients. Fasting, 30 and 120 min plasma glucose and serum insulin during 75 g oral glucose tolerance test (OGTT) were measured. Homeostasis model assessment (HOMA) was applied to assess the status of insulin resistance (HOMA-IR), and HOMA-β and the ratio of the increment of insulin to that of plasma glucose of the initial 30 min during OGTT (△I 30/△G 30) were used to evaluate the basic function and the early phase of insulin secretion of islet β cells respectively. Results As compared with NGT, age, waist circumference, body mass index (BMI), blood pressure, 120 min glucose were elevated in other 4 groups. Adjusted with age and sex, HOMA-IR was higher in subjects with IFG (1.14±0.06), IGT (1.12±0.07) and IFG & IGT than that with NGT (0.93±0.03) (P<0.05), however, there was no difference among IFG, IGT, and IFG & IGT. Compared with subjects in NGT, subjects with IFG had lower HOMA-β(4.53±0.06 vs 5.10±0.04, P<0.05), while there was no difference in △I 30/△G 30. Individuals with IGT showed lower △I 30/△G 30 than that with NGT (4.62±0.14 vs 4.99±0.11, P<0.05), but no difference in HOMA-β. Compared with subjects in IFG, HOMA-β increased in subjects with IGT (5.11±0.07 vs 4.53±0.06, P<0.05), although no difference was found in △I 30/△G 30. At the same time, subjects with DM had more severe IR (1.55±0.05 , P<0.05) and basic and postload dysfunction of β cell compared with other groups (3.94±0.06;3.93±0.12, both P<0.05). Conclusion The individuals with IFG mainly showed defect of basic β cell function, the subjects with IGT showed defect of the early phase of insulin secretion, and the patients with DM have more severe IR and defect of the basic and postload β cell function. With the deterioration of glucose metabolism from NGT to DM, the function of islet β cells is progressively decreased; eventually, failure of islet β cells.