糖耐量受损和新诊断2型糖尿病人群胰岛素分泌功能的研究

Study on insulin secretion in the subjects with impaired glucose tolerance and newly diagnosed type 2 diabetes mellitus

目的：研究葡萄糖耐量受损（IGT）、新诊断的2型糖尿病人群1相胰岛素分泌功能。方法：选择正常健康人28例、IGT者31例、新诊断的2型糖尿病患者31例,均行口服75 g葡萄糖耐量试验和减少样本数的Bergman微小模型技术结合静脉葡萄糖耐量试验（FSIGTT）,分别用胰岛β细胞功能指数（HBCI）,ΔI30/ΔG30及急性胰岛素反应（AIR）评估胰岛β细胞功能,AIR用减少样本数的Bergman微小模型技术结合FSIGTT检测;同时测定受试者的体质量指数（BMI）和腰臀比（WHR）,检测空腹状态下血脂、血糖、胰岛素、糖化血红蛋白（HbA1c）等生化指标。结果：（1）2型糖尿病组的AIR[27.4（-2.5～76.5）mU/L]显著低于正常组（270.5±128.3）mU/L及IGT组（213.3±154.4）mU/L（P＜0.01）,正常组与IGT组之间无显著差异。（2）2型糖尿病组的ΔI30/ΔG30（1.1±0.6）,HBCI（3.8±1.0）显著低于正常组（分别为2.7±0.9,4.2±1.0）及IGT组（分别为2.5±1.0,4.9±1.7）（P＜0.01）,而后两组间ΔI30/ΔG30,HBCI均无显著差异。（3）AIR与△I30／△G30,HBCI，胰岛素，BMI显著正相关（P〈0．05～P〈0．01），与血糖、年龄、HbAlc、胰岛素敏感指数（SI）显著负相关（P〈0．05～P〈0．01）。在校正年龄、BMI后，与△I30／△G30,HBCI、胰岛素（30，60，120，180min）仍显著正相关，与各时问点血糖，HbAlc显著负相关。（4）以AIR为应变量，其他变量为自变量作多元逐步回归，有BMI，△I30／AG30进入最后的方程（r^2=0．656，P〈0．01）。结论：新诊断的2型糖尿病人群AIR显著降低，而HBCI、特别是△I30／AG30与AIR有着很好的相关性，是用来评估新诊断的2型糖尿病人群胰岛素分泌功能的较为简易的方法。

Objective： To study first-phase insulin secretion in subjects with impaired glucose tolerance（IGT） and newly diagnosed type 2 diabetes mellitus（DM）.Methods： A total of 90 subjects[twenty-eight normal control（NC） subjects,31 patients with impaired glucose tolerance（IGT）,and 31 patients with newly diagnosed type 2 diabetes mellitus（DM）]underwent 75g oral glucose tolerance test and insulin-modified reduced sample number（n=12） of Bergman′s minimal model method with frequently sampled intravenous glucose tolerance test（ FSIGTT）. Insulin secretion was determined by Homa B-cell function index（HBCI）,△I30/△G30 and acute insulin response（AIR）to glucose, rameters including body mass index（BMI） and waist hip profile, plasma glucose, insulin and HbAlc levels were respectively. Meanwhile the anthropometrical pa- ratio （WHR） were evaluated and the serum lipid also measured. Results： （1） The AIR in DM group[27.4（ -2.5-76.5 ） mU/L] was significantly lower than that in NC （270.5 ± 128.3 mU/L） and IGT[ 213.3 ± 154.4 mU/L ] groups （P 〈 0. 01 ）, and there was no significant difference between IGT and NC groups. （2） The AI30/AG30 （ 1. 1 ±0. 6） and HBCI （3.8 ± 1.0） in DM group were significantly lower than that in NC （2.7 ±0.9,4.2 ± 1.0, respectively. ） and IGT （2.5 ± 1.0,4.9 ± 1.7, respectively. ） groups（P 〈0.01 ） , and there was no significant difference between IGT and NC groups. （3） As to AIR level, it was positively correlated with △I30/△G30, HBCI, insulin and BMI. （P 〈0.05 - 〈 0. 01 ） , and nega- tively correlated with glucose,age, HbAlc and insulin sensitivity index（SI） （ P 〈 0.05 - P 〈 0.01 ）. After adjustment for BMI and age, △I30/△G30, HBCI and insulin remained positively correlated with AIR. Glucose and HbA1 c remained negatively correlated with AIR . （4） In general multivariate regression, BMI and AI3o/AG3o were significantly independent determinants for AIR（r2 = 0. 656, P 〈 0.01 ）. Conclusion： The AIR decreased in newly diagnosed type 2 DM group, and was positively correlated with HBCI, especially with △I30/△G30. It suggests that △I30/△G30 can be served as a clinical evaluation index of insulin secretion.