昆明地区2型糖尿病1级亲属中糖耐量正常者胰岛β细胞功能的研究

The Study of Isletβ-cell Function in Normal Glucose Tolerance of First-degree Relatives of Type 2 Diabetes in Kunming

目的研究2型糖尿病1级亲属中糖耐量正常者糖、脂类、胰岛β细胞功能的变化,以了解2型糖尿病易患因素的遗传性,根据这些变化指导临床制定出更早预防糖尿病发生的措施.方法选择2型糖尿1级亲属糖耐量正常者111人为实验组,3代无糖尿病家族史健康111人为对照组,记录年龄、性别、身高、体围、体重,过夜禁食8～12h,抽肘静脉血查血脂、肾功、C-RP、胰岛素抗体(IAA)、谷氨酸脱羧酶抗体(GAD60)、胰岛细胞抗体(ICA),OGTT试验、胰岛及C-肽释放试验,并计算体重指数(BMI),腰臀比(WHR)、胰岛素抵抗指数(HOMAIR)、β细胞功能指数(HOMAβ)、OGTT中30min和空腹胰岛素与血糖差值的比△I30/△G30、胰岛素敏感指数(IAI),OGTT葡萄糖、胰岛素及C肽释放实验的曲线下面积,并对以上两组指标进行比较.结果2型糖尿病1级亲属中糖耐量正常者与3代无糖尿病家族史的健康人比较BMI、甘油三脂(TG)、CRP、OGTT试验中的30、60min的血糖、胰岛素,服糖后60min的胰岛素、10min及120minC-肽,OGTT葡萄糖、胰岛素及C肽释放实验的曲线下面积均增高(P<0.05).HOMAIR、HOMAβ、△I30/△G30、IAI、IAA、GAD60、及ICA无显著差异(P>0.05).结论2型糖尿病1级亲属中糖耐量正常者已经发生胰岛β细胞功能的异常变化,即胰岛素的生理作用下降,即使糖耐量正常,但已表现出糖负荷后血糖OGTT葡萄糖、胰岛素及C肽释放实验的曲线下面积的值高于正常对照组,BMI、TG、CRP已示增高.2型糖尿病的1级亲属是2型糖尿病发生的高危人群,在糖耐量正常阶段就应该采取糖尿病的1级综合预防措施,阻止和(或)延缓这部分糖尿病高危人群的人不进入或延迟进入糖尿病自然病程的第3期,从而不发生或延迟发生糖尿病.

Objective To study the variations of glucose, lipid, and islet β-cell function of the first-degree relatives of type 2 diabetes to investigate the genetic inheritance which is prone to develop type 2 diabetes. According to these changes, To provide suggestion for clinic doctors to how to prevent type 2 diabetes earlier. Methods We recruited 111 normal glucose tolerance of the first-degree relatives of type 2 diabetes,and 111 health people without family history of three-generation as controls. Age, sex, height, weight were recorded. Overnight fasting for 8 to 12 hours, lipid, renal function, C-reactive protein （CRP）, insulin autoantibody （IAA）, glutamic acid decarboxylase antibody60 （GAD60）, islet cell antibody （ICA）, oral glucose tolerance test, insulin releasing test and C-peptide releasing test to glucose stimulation were measured by drawing blood sample from antecubital vein. We calculated body mass index, waist-hip ratio,homeostasis model assesment of insulin resistance （HOMAIR）, β cell function index （HOMAβ）, insulin sensitivity indices（ISI）, glu （AUC）, Ins （AUC）, C-pep （AUC）. Results compared withthecontrols, BMI, triglyceride （TG）, CRP, plasma glucose of 30 minute, 60 minute, of OGTT, fasting insulin, Insulin 60, C-peptide of 10 and 120minute, glu （AUC）, Ins （AUC）, C-pep （AUC） of the first degree relatives of type 2 diabetes were significantly increased （P〈0.05）. HOMAIR, HOMAβ, △I30/△G30, IAI, IAA, GAD, ICA had no difference （P 〉 0.05）. Conclusions The first degree relatives of type 2 diabetes with normal glucose tolerance had islet 15 cell dysfunction insulin resistance and the decreased insulin sensitivity. Although these subjects have normal glucose tolerance, their glucose after oral glucose changing, BMI , TG , CRP are higher than the controls. The first degree relatives of type 2 diabetes have high risk to develop to type 2 diabetes. Primary preventive measures should be taken at normal glucose tolerance stage to delay the progression to the third stage of natural history of type 2 diabetes and avoid diabetes.