Ⅱ型糖尿病胰岛素分泌和血糖清除能力的临床研究

CLINICAL OBSERVATION OF INSULIN SECRETION AND GLUCOSE CLEARANCE IN TYPE Ⅱ DIABETES MELLITUS

对96例Ⅱ型糖尿病(NIDDM)病人做进食100g标准粉馒头餐(相当于75g葡萄糖)耐量试验;结果表明随空腹血糖(FPG)升高,2h平均胰岛素分泌量(MIS)呈先升高后下降改变,当FPG>10.0mmol/L,MIS曲线幅度低平;提示轻型或早期NIDDM病人的主要病理生理异常是胰岛素抵抗(IR);重型或晚期病人则是胰岛素分泌降低或不足。2h平均血糖增值(MPGI)在NIDDM组显著高于对照组,但在NIDDM各组之间无明显差异;说明餐后葡萄糖清除能力下降是NIDDM重要特征,且与β细胞功能无关。推测NIDDM病人FPG升高与禁食后肝葡萄糖释放或内源葡萄糖产生过多有关,而餐后高血糖症可能与葡萄糖-胰岛素调节下靶细胞受体与受体后葡萄糖摄取和利用障碍或IR有关。

An 100g steamed bread meal tolerance test was carried out in 96 patients with non- insulin-dependent diabetes mellitus (NIDDM). The results showed that as the fasting plasma glucose (FPG) increased progressively, the mean insulin escretion (MIS) at 2h first increased and them decreased. when the FPG was over 10.0mmol/L, the MIS curve became low and flat. This indicates that the main physiopathologic abnormality is insulin resistance (IR) of the tissues at the early stage of the disease and decreased or insufficient insulin secrements (MPGI) after the meal were found significantly higher in the patients than in the controls, but no significant difference was seen among the pa- tient groups. This shows that insufficient glucose clearance is characteristic of NIDDM and is not correlated to the function of the β-cell. It can be inferred that the excessive re- lease of hepatic glucose of the excessive production of endogenetic glucose after 12 hours fasting overnight contributes to the increase of FPG in diabetes and that postpran- dial huperglycemia may be linked to the inorchestration of the glucose-and insulin-in- duced modulation of glucose uptake and utilization or insulin resistance.