正常糖耐量与糖代谢异常人群胰岛素抵抗和β细胞功能330例分析报告

Study on the Insulin Resistance and β-Cell Function in Individuals with Normal and Those with Abnormal Glucose Metabolism

目的:分析报告正常糖耐量(NGT)与糖代谢异常人群的胰岛素抵抗(IR)和胰岛β细胞分泌功能。方法:选用2h胰岛素(2hIns)与2h血糖(2hPG)的比值(2hIns/2hPG)、胰岛素抵抗指数(IR I)、胰岛素敏感指数(ISI)和30m in净增Ins/30m in净增血糖(ΔI30/ΔG30),分析NGT、糖耐量受损(IGT)和未诊断、未治疗糖尿病(DM)病人的IR和β细胞分泌功能。结果:从NGT、IGT到新诊断DM组,IR I水平表现为进行性升高的趋势,分别为2.0±1.5、3.1±1.6、4.1±1.8;而2hIns/2hPG、ΔI30/ΔG30和ISI水平进行性降低。组间两两比较差异有统计学意义(P<0.01)。ΔI30/ΔG30和ISI水平与病程显著相关,病程<3年和≥3年两组(2.9±3.2 vs 2.4±2.3、30.2±1.1 vs 23.4±2.3)间比较差异有统计学意义(P<0.01)。多元逐步回归分析结果显示,各指标都进入回归方程。除年龄、2hCP与ISI无相关性外,性别、2hIns/2hPG、ΔI30/ΔG30均与ISI呈显著相关(F值分别为96.3、58.4和47.5,P<0.01)。主要成分分析结果显示,2hIns/2hPG、ISI、2hCP、ΔI30/ΔG30累计贡献率已超过85%(86.5%)。结论:从NGT、IGT到DM2的发展过程中,随着IR的不断加重,胰岛β细胞分泌功能也逐渐减退,多元逐步回归分析和主要成分分析结果显示,2hIns/2hPG、ISI、2hCP、ΔI30/ΔG30、FCP都是反映糖代谢异常人群IR和胰岛β细胞分泌功能障碍的有用指标。

Objective To study the insulin resistance and β-cell function in individuals with normal glucose tolerance （NGT） and those with glucose metabolism dysfunction. Methods Insulin resistance and β- cell function were studied with oral glucose tolerance test and the following parameters： 2h insulin/2h plasma glucose （2hIns/2hPG）, insulin resistance index （IRI）, insulin sensitivity index （ISI） and 30min net increment of insulin/30min net increment of glucose （ΔI30/ΔG30） were examined in 44 individuals with NGT, 45 subjects with impaired glucose tolerance （ IGT）, 66 recently diagnosed diabetics and 175 well - established diabetics. Resuits The insulin resistance index （IRI） increased progressively from that in NGT individuals to that in recently diabetics （2.0 ±1. 5 →3.1± 1.6→4.1±1.8）, while the 2hIns/2hPG, ΔI30/ΔG30 and ISI decreased progressively with significant differences between those in successive groups （P 〈 0.01 ）. In well -establised diabetics, the IRI kept stable but the ΔI30/ΔG30 and ISI kept decreasing （ values in patients with disease history less than 3 yrs vs those in patients with disease over 3yrs ： 2.9 ± 3.2 vs 2.4 ± 2.3, 30.2 ±1.1 vs 23.4 ± 2.3, P 〈 0.01 ）. In multiple regression display, Sex, 2hIns/2hPG and ΔI30/ΔG30 were significantly correlated with ISI （ F =96.3, 58.4 and 47.5 respectively）. For principal component analysis display, the cumulative contribution rate of four parameters （2hIns/2hPG, ISI, ΔI30/ΔG30 and 2h C -peptide） exceeded 85% （86.5%）, Conclusion As the dysfunction of glucose metabolism proceeded from IGT to well established diabetes, the IR increased first with decrease of β -cell secretion followed. The parameters 2hIns/2hPG, ISI, 2h C -peptide ΔI30/ΔG30 were especially useful for the investigation. Kay Words impaired glucose tolerance, diabetes mellites type 2, insulin resistance, β-cell function