2型糖尿病和非酒精性脂肪肝病患者的胰岛素抵抗和胰岛β细胞功能

Insulin resistance and islet beta cell function in type 2 diabetes mellitus and non alcoholic fatty liver disease

目的探讨2型糖尿病（T2DM）和非酒精性脂肪肝病（NAFLD）患者胰岛B细胞功能和胰岛素抵抗的特征。方法206例研究对象根据是否有T2DM和NAFLD分为4组，采用肝脏胰岛素抵抗指数（HIR）、HOMA胰岛素抵抗指数（HOMA—IR）及Matsuda指数（MSI）评估胰岛素抵抗性，采用HOMA—β、早相及晚相胰岛素分泌指数评估胰岛β细胞功能。结果NAFLD组和T2DM伴NAFLD组的HIR均显著高于对照组和T2DM组（4．13±0．64，4．03±0．69比3．52±0．78，3．53±0．64，P〈0．05），T2DM伴NAFLD组的HOMA—IR显著高于T2DM和NAFLD组（3．35±2．69比2．31±1．39，2．40±1．55，P〈0．05）；NAFLD组的早相胰岛素分泌指标显著低于对照组（2．13±0．17比2．61±0．13，P〈0．05），而T2DM组和T2DM伴NAFLD组的HOMA．B、早相及晚相胰岛素分泌指标均明显低于对照组（P〈0．05）。结论NAFLD患者主要表现为肝脏胰岛素抵抗，其胰岛β细胞早相胰岛素分泌受损；T2DM患者存在胰岛素抵抗，其胰岛β细胞早、晚相胰岛素分泌功能均受损。当患者既有T2DM又有NAFLD时，胰岛素抵抗将更严重。

Objective To investigate insulin resistance and islet beta cell function in type 2 diabetes mellitus（T2DM） and non alcoholic fatty liver disease （NAFLD）. Methods Two hundred and six study subjects were classified into 4 groups. Hepatic insulin resistance index （HIR）, HOMA insulin resistance index（HOMA-IR） and Matsuda index （MSI） were used to assess insulin resistance. HOMA-β, early and late phase indexes of insulin secretion were used to evaluate islet beta cell function. Results HIR in the NAFLD group and T2DM with NAFLD group were significantly higher than that in the control group and T2DM group（4. 13 ±0. 64, 4. 03 ±0. 69 vs 3.52 ±0. 78, 3.53 ±0. 64, P 〈0. 05）, HOMA-IR in the T2DM with NAFLD group was significantly higher than that in the NAFLD group and T2DM group （3.35±2.69 vs 2. 31 ± 1.39, 2.40± 1.55, P 〈 0. 05）. Early phase insulin secretion index in the NAFLD group was lower than that in the control group significantly（2. 13 ±0. 17 vs 2. 61 ±0. 13 ,P 〈0. 05）, but there was no significant difference of HOMA-β and late phase insulin secretion index between the NAFLD group and control group, HOMA-β, early and late phase indexes of insulin secretion in the T2DM group and T2DM with NAFLD group were significantly lower than those in the control group. Conclusions Normal glucose tolerance NAFLD patients may present with insulin resistance, mainly hepatic insulin resistance. Islet beta cell function in the NAFLD patients show damage of early phase insulin secretion. Newly diagnosed T2DM with or without NAFLD patients generally present with insulin resistance, early and later phase insulin secretion dysfunction. Insulin resistance in patients with T2DM and NAFLD is more severe.