有2型糖尿病家族史非肥胖青少年胰岛素抵抗的研究

Insulin resistance in non-obese adolescents with family history of type 2 diabetes

目的探讨有2型糖尿病家族史非肥胖青少年胰岛素抵抗状态及相关危险因素。方法80名13～15岁体重指数（BMI）正常青少年，根据有无糖尿病家族史分为糖尿病家族史阳性组（FH^＋）和阴性组（FH^-）。测量身高、体重、腰围及血压。空腹静脉采血，检测血糖、血脂、真胰岛素（TI）及可溶性细胞间黏附分子1（sICAM-1）。结果FH^＋组BMI、腰围、空腹血糖、T1、稳态模型评估的胰岛素抵抗指数（HOMA—IR）和sICAM-1高于FH^-组（P〈0．05）。HOMA—IR与BMI、腰围、空腹血糖、TI和sICAM-1呈正相关（均P〈0．05）。以In（HOMA—IR）为因变量，行多元线性回归显示，腰围（B=0．047，P〈0．01）和sICAM-1（β=0．074，P=0．014）被引入方程。结论有2型糖尿病家族史非肥胖青少年已存在明显胰岛素抵抗，腹部脂肪聚集和血管内皮功能障碍与胰岛素抵抗密切相关。

Objective To investigate the changes of insulin resistance and related risk factors in non-obese adolescents with family history of type 2 diabetes. Methods 80 non-obese adolescents aged 13- 15 years with or without family history of diabetes [ FH^＋ group （ n = 40） and FH^- group （ n = 40 ） ] were included in this study. Anthropometric measurements, including height, weight, waist circumference and blood pressure were performed. Blood samples were collected and fasting plasma glucose（FPG）, serum lipids, true insulin （TI） and soluble intercellular adhesion molecule-1 （sICAM-1） were assayed. Results FH^＋ group had performed significantly higher levels of body mass index （ BMI ）, waist circumference, FPG, TI, homeostasis model assessment for insulin resistance （HOMA-IR） and sICAM-1 than FH-group （P〈0.05）. HOMA-IR showed positive correlation with BMI（r=0.353）, waist circumference （r=0. 338）, FPG（r=0.463）, TI （r= 0.991） and sICAM-1 （r=0. 161, all P〈0.05）. In multiple linear regression analysis, waist circumference （β=0.047, P〈0.01） and sICAM-1 （β=0. 074, P=0. 014） were significant independent predictors for In （HOMA-IR）. Conclusions These results indicate that insulin resistance exists in non-obese adolescents with family history of type 2 diabetes. Visceral fat accumulation and endothelial dysfunction are associated with insulin resistance.