初发单纯空腹高血糖和（或）单纯餐后高血糖型糖尿病的代谢特征

The metabolic characteristics of insulin secretion and insulin sensitivity in diabetic patients with newly diagnosed WH and/or IPH

目的评估单纯空腹高血糖型糖尿病（IFH），单纯餐后高血糖型糖尿病（IPH）及空腹合并餐后高血糖型糖尿病（FPH）的临床特点和胰岛素分泌及胰岛素敏感性的特征。方法2004至2005年瑞金医院内分泌门诊初诊糖尿病患者704例，据75g葡萄糖耐量试验分为：（1）IFH81例；（2）IPH147例；（3）FPH476例。比较各组的胰岛素分泌及胰岛素敏感性指标。结果3组患者的年龄，体重指数，腰围及血压的差别无统计学意义。空腹胰岛素（0min）3组差异无统计学意义，30、60min胰岛素FPH低于其他两组，120win胰岛素IPH高于其他两组（均P〈0．05）。FPH组较IFH和IPH组有显著的早期相胰岛素分泌缺陷；IPH组和FPH组较IFH组的胰岛素敏感性降低。结论β细胞分泌缺陷和胰岛素抵抗均是从IFH向FPH进展的重要因素，而在IPH向FPH进展的过程中，β细胞的胰岛素分泌缺陷可能起到关键性的作用。

Objective To evaluate the metabolic characteristics of insulin secretion and insulin sensitivity in diabetic patients with isolated fasting hyperglycemia （IFH） and （or） isolated postchallenge hyperglycemia （IPH）. Methods From the outpatient clinic, 704 subjects were classified into the following three groups, based on the results of 75 g oral glucose tolerance test （OG1T） ： （1） IFH （n =81） ; （2） IPH （n = 147） and （3） FPH （fasting and postchallenge hyperglycemia, n = 476 ）. Insulin secretion （ insulinogenic index ） and insulin sensitivity （insulin sensitivity index） of 3 groups were compared. Results There was no significant difference in age, body mass index, waist circumference and blood pressure in 3 groups. There was no difference in fasting insulin level （0 min） among 3 groups, whereas insulin levels at 30 min and 60 rain in FPH group were lower than those in other 2 groups, and insulin level at 120 rain in IPH group was higher than those in other 2 groups （ all P 〈 0.05）. Subjects with FPH exhibited distinctly impaired early-phase insulin secretion as compared with IFH group and IPH group. Compared with subjects with IFH, insulin sensitivity decreased in subjects with IPH and FPH. Conclusion Both deficiency of insulin secretion and insulin resistance are the causes of deterioration from IFH to FPH, while the decreased early-phase insulin secretion plays an important role in deterioration from IPH to FPH.