2型糖尿病家系非糖尿病一级亲属胰岛素抵抗的多因素分析

Multiple factor analysis of insulin resistance in the non-diabetic first degree relatives of type 2 diabetic pedigrees

目的:研究2型糖尿病家系非糖尿病一级亲属胰岛素抵抗和体质量指数、血脂、血糖、胰岛素、C肽等参数的关系。方法:在重庆地区选择有两个或两个以上2型糖尿病患者的103个家系进行调查。对先证者的父母、同胞、和子代进行标准口服葡萄糖耐量实验,根据糖耐量结果确定无糖尿病者125例为一级亲属组。选择糖尿病患者或糖尿病家系一级亲属的配偶83例为正常对照组。比较两组空腹血糖、空腹胰岛素、空腹C肽、血脂,及糖负荷后60,120,180min血糖、胰岛素、C肽水平,并计算体质量指数及胰岛素抵抗稳态模型评估胰岛素抵抗指数(HOMA-IR),用于评价胰岛素抵抗变化。将一级亲属组成员根据体质量指数分组。比较肥胖者(n=57)和非肥胖者(n=68)的指标改变。结果:一级亲属组收缩压、舒张压、三酰甘油、总胆固醇、低密度脂蛋白胆固醇、HOMA-IR明显高于正常对照组(t=1.98～2.50,P<0.05～0.01)。葡萄糖负荷后60,120min的血糖及0,60min,120min的胰岛素,负荷后60min的C肽,均显著高于对照组(t=2.07～4.82,P<0.05～0.01)。一级亲属组肥胖者的三酰甘油,高密度脂蛋白胆固醇、低密度脂蛋白胆固醇空腹胰岛素水平及HOMA-IR明显高于非肥胖者t=2.03～7.56,P<0.05～0.01)。糖尿病一级亲属组HOMA-IR(与体质量指数,收缩压、舒张压。

AIM:To study the correlations of insulin resistance with body mass index(BMI), blood lipid, blood glucose,insulin and C peptide in the non diabetic first degree relatives of type 2 diabetic pedigree. METHODS:Totally 103 families with 2 or more type 2 diabetic patients in Chongqing were investigated.Oral glucose tolerance test(OGTT) was applied to the parents, sibling and children of the proposita,and 125 non diabetic siblings were selected as the first degree relative group,and 83 spouses of them were taken as normal controls.Fasting blood glucose, fasting C peptide, blood lipid,and blood glucose,insulin and C peptide levels at 60,120 and 180 minutes after glucose load in OGTT were compared between the two groups.BMI and homeostasis model assessment insulin resistance(HOMA IR) were calculated for evaluation of IR changes.Subjects in the first degree relative group were grouped according to BMI,and then the changes of the indexes were compared with those with obesity(n=57) and non obesity(n=68). RESULTS:The systolic blood pressure(SBP),diastolic blood pressure(DBP),total cholesterol(TC),triacylglycerol(TG), low density lipoprotein cholesterol(LDL C) and HOMA IR in the first degree relative group were obviously higher than those in the normal control group(t=1.98 to 2.50, P < 0.05 to 0.01).After glucose load, blood glucose at 60 and 120 minutes, insulin at 0, 60 and 120 minutes, and C peptide at 60 minutes were all significantly higher in the first degree relative group than in the normal control group(t=2.07 to 4.82, P< 0.05 to 0.01).In the first degree relative group,the levels of TG, LDL C and fasting insulin and HOMA IR of the obese subjects were remarkably higher than those of the non obese ones(t=2.03 to 7.56, P< 0.05 to 0.01).HOMA IR had significantly positive correlation with BMI, SBP, DBP and TG in the first degree relative group (r=0.516,0.377,0.413,0.406,P< 0.01). CONCLUSION:Insulin resistance and dyslipidemia exist in the first degree relatives of type 2 diabetic families.With the increase of BMI,the severities of insulin resistance and dyslipidemia are increased in the first degree relatives.The levels of blood pressure and lipid are correlated with insulin resistance.