新诊断2型糖尿病患者不同临床表型胰岛素分泌和胰岛素敏感性的研究

Comparison of insulin secretion and sensitivity in subcategories of newly diagnosed type 2 diabetes in chinese patients

目的探讨新诊断2型糖尿病患者单纯空腹高血糖（IFH）、单纯餐后高血糖（IPH）和空腹并餐后高血糖（CH）三种临床表型间胰岛B细胞功能和胰岛素敏感性的改变及其临床特征的差异。方法于2001-03～2002—06对青岛地区的糖尿病流行病学调查中，新诊断2型糖尿病患者335例，性别、年龄与糖尿病组相匹配的正常糖耐量个体411例，应用稳态模型评估法（HOMA—IR）、李光伟指数（IAI）评价胰岛素抵抗，稳态模型B细胞基础功能指数（HOMA—B）和空腹血浆胰岛素与葡萄糖比值（I0／G0）评价基础状态下的胰岛B细胞分泌功能，糖刺激后2h胰岛素与葡萄糖比值（I120／G120）评价负荷后2h的胰岛B细胞分泌功能。结果CH组的HOMA—IR较IFH组和IPH组差异有显著性（P〈0.05），CH组的InIAI较IFH组和IPH组差异有显著性（P〈0.05）。校正年龄、性别、体重指数、收缩压、InHOMA—IR等因素后，InHOMA—B和In I0／G0呈现按NGT—IPH—IFH—CH逐渐降低趋势，In I120／G120则按NGT—IFH—IPH—CH逐渐降低。多因素Logistic回归分析表明：体重指数和HOMA—IR是IFH的独立患病危险因素，HOMA—B是IFH的保护因素。体重指数和甘油三酯是IPH的独立患病危险因素，HOMA—B和I120／G120是IPH的保护因素。结论空腹并餐后高血糖（CH）的胰岛素抵抗程度和胰岛B细胞功能受损程度最严重。

Objective To compare the demographic and anthropometric characteristics of IFH, IPH and CH in a Chinese newly diagnosed diabetes population and to evaluate the metabolic profiles of insulin secretion and insulin sensitivity associated with subcategories of newly diagnosed type 2 diabetes. Methods From Mar. 2005 to June 2002, in Qingdao 335 patients with newly diagnosed diabetes were classified into three groups： IFH （n =67）, IPH （n =92）, and CH （n = 176） . Meanwhile, 411 （191males） subjects with age- sex matched were selected as control group. Homeostasis model assessment （HOMA- IR） and LIGUANGWEI index （IAI） were applied to assess the status of insulin resistance. Homeostasis model assessment （HOMA -B） and I0/G0 were applied to assess the basic function of islet B cell, and I1200/G120 was applied to assess the postload function of islet B cell. Results HOMA - IR increased and IAI decreased significantly in CH group than in IFH and IPH group （P 〈0. 05） . The decrease, tendency of HOMA - B and I0/G0 was NGT→IPH→IFH→CH, while I120/G120 were decreased by the tendency of NGT→IFH→IPH→CH after adjusted with age, sex, systolic blood pressure, BMI and InHOMA - IR. Multivariable Logistic analysis results showed BMI and HOMA - IR were independent risk factors and HOMA - B were protective factors related to IFH, BMI and triglyceride were independent risk factors while HOMA - B and I120/G120 was protective factor related to IPH. Conclusion CH presents the worst insulin resistance and insulin secretion in these three subcategories of diabetes. An individualized therapy seems to be beneficial for different group.