用改进的最小模型对糖耐量减退和Ⅱ型糖尿病患者胰岛素抵抗致病机制的研究

MECHANISM OF INSULIN RESISTANCE IN PATIENTS WITH IMPAIRED GLUCOSE TOLERANCE AND TYPE II DIABETES MELLITUS

用改进的最小模型分别对正常人、IGT(糖耐量减退)和NIDDM(II型糖尿病)患者进行胰岛素敏感指数(S_1)、胰岛素自身代谢效能(S_G)及胰岛β细胞功能分析.结果表明:改进的最小模型与标准的最小模型相比较,两种方法对评估S_1和S_G有高度的相关性(S_1·r=0.856,P<O.0025;S_G,r=0.717,P<O.0025);在正常人中,其S_1与S_G均明显高于IGT和NIDDM者.在IGT和NIDDM者中,IGT者S_1明显低于NIDDM者(P<O.05),而其S_G虽低于NIDDM者,但两者间差异没有显著性;3组中,正常人胰岛素曲线下面积(AUC_1)明显小于IGT者(P<0.05),但显著高于NIDDM组(P<O.02),而其胰岛素曲线下面积(AUC_2)却明显低于IGT和NIDDM者.从而表明用改进的最小模式不失为一理想的评估S_1和S_G方法.NIDDM者中,尤其IGT者存在明显的胰岛素抵抗和β细胞分泌异常现象,提示胰岛素抵抗在NIDDM 发病机制中占有重要位置.

Insulin sensitivity index (SI).glucose effectiveness (SG) and insulin secretion function were assessed by modified minimal model method (MMM) with frequently sampled intravenous glucose tolerance (FSIGT) test in the controls, in patients with impaired glucose tolerance (IGT), and type II diabetes mellitus (NIDDM). There was significant correlation between modified MMM and standard MMM in evaluating SI and SG. The results indicated that SI and SG were significantly elevated in the control than in the IGT and NTDDM groups. SI diminished much more in IGT group than in NIDDM group (P<0. 05); however, there was no significant difference in SG between IGT and NTDDM groups. As compared with IGT and NIDDM groups, insulin secretion of area under curve 1 (AUC1) in controls was smaller than that in IGT (P<0. 05),but much larger than that in NIDDM (P<0. 02). AUC2 in controls was the least of the three groups,but AUC2 was elevated more in IGT than in NIDDM. These results may implicate that in patients with NTDDM, particularly with IGT,there are obvious phenomenon of insulin resistance and abnormal β cell secretion and insulin resistance has an important effect in the pathogenesis and development of IGT and NIDDM. The modified MMM is an ideal method for evaluating SI and SG.