葡萄糖耐量试验对早期糖尿病筛查及转归的预测研究

The study of oral glucose tolerance test on screening and predicting the development of diabetes mellitus

目的:研究糖尿病早期筛查的意义,评估其胰岛素敏感性及分泌功能,同时预测其发生糖尿病及其相关并发症的转归情况,为临床早期干预提供指导。方法:通过对患者进行口服葡萄糖耐量试验(OGTT),计算其体质指数,同时行血脂检测,早期筛查糖尿病并评估其胰岛素敏感性。结果:糖耐量减低(IGT)组患者平均年龄低于糖尿病(DM)组(52.0±10.9vs65.1±14.3,P<0.05);与正常葡萄糖耐量(NGT)组患者相比,空腹血糖调节受损(IFG)组、IGT组患者及DM组患者胰岛素敏感性(ISI0,120)明显下降,胰岛素抵抗明显(NGT vs IFG:92.0±22.3vs69.1±22.0;NGT vs IGT:92.0±22.3vs64.7±13.1;NGT vs DM92.0±22.3vs28.5±8.2,P<0.05);IGT组患者较IFG组患者胰岛素敏感性下降更明显(IFG vs IGT69.1±22.0vs64.7±13.1,P<0.05);胰岛素生成指数(IGI)IGT组明显高于IFG组(IFG vs IGT:1.69±0.80vs1.90±1.20,P<0.05);与NGT组相比,IFG组及DM组胰岛素早期相分泌(EPIR)明显降低(NGT vs IFG1stPH:243.9±173.5vs124.2±110.2,2ndPH:99.2±33.5vs62.6±37.4;NGT vs DM1stPH:243.9±173.5vs136.7±123.2,2ndPH:99.2±33.5vs38.8±33.3,P<0.05);且IGT组高于IFG组(IFG vs IGT1stPH:124.2±110.2vs200.4±186.3,P<0.05)。结论:IFG患者与IGT患者可能存在不同的发病机制,部分患者在正常葡萄糖耐量(NGT)时已经存在β细胞功能受损,OGTT检查对于揭示胰岛分泌功能及胰岛素抵抗,早期筛查糖尿病具有重要的意义,从而对糖尿病早期诊断早期干预提供临床指导意义。

Objective：To research the significance of screening diabetes mellitus early,evaluate the insulin sensitivity and the function of secretion,and predict the development of diabetes and the complications,and provide early intervention for the patients. Methods：All the patients had oral glucose tolerance test（OGTT）,and the body mass index（BMI） was calculated,and screening diabetes mellitus early and evaluation the sensitivity to insulin were performed. Results：The group of impaired glucose tolerance （IGT） patients,were younger than the group of diabetes mellitus （DM）（52.0±10.9 vs 65.1±14.3,P 〈 0.05）. Compared with the group of normal glucose tolerance（NGT）,the insulin sensitivity is decreased in the groups of impaired fasting glucose（IFG）,IGT and DM,and insulin resistance was more obvious（NGT vs IGT：92.0±22.3 vs 64.7±13.1;NGT vs DM：92.0±22.3 vs 28.5±8.2. P 〈 0.05）. Compared with the group of IFG,the insulin sensitivity of IGT decreased more. Compared with the group of IFG,the insulinogenic index （IGI） was higher in IGT （IFG vs IGT：1.69±0.80 vs 1.90±1.20,P 〈 0.05）,and compared with the group of NGT,the early-phase insulin re lease （EPIR） was lower in IFG and DM （NGT vs IFG 1stPH：243.9±173.5 vs 124.2±110.2,2ndPH：99.2±33.5 vs 62.6±37.4;NGT vs DM 1stPH：243.9±173.5 vs 136.7±123.2,2ndPH：99.2±33.5 vs 38.8±33.3,P 〈 0.05）,and 1stPH in IGT was higher than that in IFG （IFG vs IGT 1stPH：124.2±110.2 vs 200.4±186.32,P 〈 0.05）. Conclusion：There are different pathogenesis in the patients of IFG and IGT,pancreas,β-cells are damaged in some patients of NGT,and OGTT has significant clinical meaning for revealing the function of pancreas β-cells, secretion and insulin resistance,and can direct screening,diagnosis and intervention for diabetes mellitus early.