血糖失控伴腹型肥胖的2型糖尿病患者的临床特点分析

Analysis of clinical characteristics of type 2 diabetes patients with central obesity and poorly-controlled blood glucose

目的:探讨血糖失控伴腹型肥胖的2型糖尿病(T2DM)患者的临床特点。方法:选取糖化血红蛋白(HbA1c)≥7.5%的T2DM住院患者258例,按腰围分为腹型肥胖组(CO组,男>90cm,女>85cm)和非腹型肥胖组(NCO组,男≤90cm,女≤85cm),并进一步根据病程将其分为A亚组(1年<病程≤5年)、B亚组(5年<病程≤10年)和C亚组(病程>10年),比较各组的糖脂代谢、胰岛素分泌指数(HOMA2-%β)和胰岛素敏感性指数(HOMA2-%S)。结果:①校正年龄、性别、病程后,CO组的三酰甘油(TG)、C反应蛋白(CRP)、血糖和C肽(CP0、CP30、CP120)均较NCO组显著升高,而高密度脂蛋白-胆固醇(HDL-C)、HOMA2-%S明显降低。②校正年龄、性别后,CO组的不同病程亚组间比较结果显示,CO-C亚组的CP30较CO-B亚组及CO-A亚组明显下降,而其HOMA2-%β较CO-B亚组显著降低(P均<0.05)。结论:血糖失控伴腹型肥胖的T2DM患者多伴TG水平升高,胰岛素抵抗(IR)程度较重,且随着病程的延长,胰岛素分泌功能下降显著。

Objective To analyze the clinical characteristics of type 2 diabetic patients with central obesity and poorly-controlled blood glucose. Methods A total of 258 type 2 diabetic patients with HbAlc 〉17.5 % were enrolled in the study. All the patients were divided by waist circumstance into central obesity group （group CO,male〉90 cm, female〉85 cm）and non-central obesity group （group NCO,male≤90 cm, female≤85 cm）, and these patients of two groups were further divided by disease duration into subgroup A （1 〈disease duration ≤5y）, subgroup B （5 〈disease duration ≤ 10y） and subgroup C （duration 〉10y）. Differences in glucose and lipid metabolism, insulin secretion index （HOMA2-%β） and insulin sensitivity index （HOMA2-% S） among these subgroups were analyzed. Results ① Subjects grouped according to the waist circumference with their age, gender, disease duration corrected showed that triglycerides, C-reactive protein, blood glucose and C-peptide （CP0, CP30 and CP120） in central obesity group were significantly higher than that in non-central obesity group, and high-density lipoprotein cholesterol, HOMA2-%S were significantly lower. ②With age and gender corrected, CP30 decreased significantly in CO-C subgroup than that in CO-A and CO-B subgroups, and HOMA2-%β in CO-C subgroup was significantly lower than that in CO-B subgroup. Conclusions Increased triglyceride and severe insulin resistance are major clinical manifestations of type 2 diabetic patients with central obesity and poorly controlled blood glucose, and with the extension of disease duration, the insulin secretion progressively decline.