初诊肥胖与非肥胖2型糖尿病IR、AIR和OS变化

DIVERSIFICATION OF THE INSULIN RESISTANCE,ACUTE INSULIN RESPONSE AND OXIDATIVE STRESS IN NEWLY-DIAGNOSED OBESE AND NON-OBESE PATIENTS WITH TYPE 2 DIABETES

目的研究肥胖与非肥胖初诊2型糖尿病（2DM）病人胰岛素抵抗（IR）、急性期胰岛素分泌（AIR）及氧化应激（OS）的特点,以探讨初诊2DM病人中肥胖对IR、AIR和OS的影响。方法对正常对照组（A组）36例、单纯初诊2DM组（B组）38例、并肥胖的初诊2DM组（C组）60例病人施以精氨酸刺激试验并计算胰岛素抵抗指数（HOMA-IR）、真胰岛素增值（△TI）,同时对三酰甘油（TG）、总胆固醇（TC）、低密度脂蛋白-胆固醇（LDL-C）、高密度脂蛋白-胆固醇（HDL-C）、空腹血糖（FBG）、丙二醛（MDA）等水平进行分析和比较。结果 B、C组TG、LDL-C、FBG显著高于A组（F=9.51~36.13,q=4.01~11.86,P〈0.05）。A、C两组△TI显著高于B组（F=4.26,q=3.14、3.96,P〈0.05）。A、B、C组HOMA-IR、MDA依次升高,差异有显著性（F=36.42、36.45,q=3.85~12.06,P〈0.05）。C组HOMA-IR与MDA、TC、LDL-C水平呈正相关（r=0.240~0.553,P〈0.05）;△TI与FBG、TG水平呈负相关（r=-0.805-、0.700,P〈0.05）;MDA和FBG、TG、TC、LDL-C水平呈正相关（r=0.227~0.839,P〈0.05）。结论初诊2DM病人存在IR和AIR异常及OS。与非肥胖2DM病人相比,肥胖2DM病人IR及OS程度更为严重,但胰岛β细胞AIR相对充分。

Objective To study insulin resistance（IR）,acute insulin response（AIR） and oxidative stress（OS） in newly-diagnosed obese and non-obese patients with type 2 diabetes（2DM） for further exploring the effects of obesity on IR,AIR and OS of the disease. Methods A total of 134 subjects [including 36 normal controls（group A）,38 non-obese patients with 2DM（group B） and 60 obese patients with 2DM（C group C） ] underwent arginine stimulation test for calculating HOMA-IR and △TI.Triglyceride（TG）,total cholesterin（TC）,low density lipoprotein-cholesterol（LDL-C）,high density lipoprotein-cholesterol（HDL-C）,fasting blood glucose（FBG）,malonaldehyde（MDA）,the results were analyzed and compared among different groups.Results Compared with group A,TG,LDL-C and FBG were higher in groups B and C（F=9.51-36.13;q=4.01-11.86;P0.05）.Compared with group B,△TI was higher in groups A and C（F=4.26;q=3.14,3.96;P0.05）.The HOMA-IR and MDA in groups B and C were higher than that in group A,and they were the highest in group C（F=36.42,36.45;q=3.85-12.06;P0.05）.In group C,HOMA-IR was positively correlated with MDA,TC,and LDL-C（r=0.240-0.553,P0.05） and △TI was negatively correlated with FBG and TG（r=-0.805,-0.700;P0.05）;MDA was positively correlated with FBG,TG,TC,and LDL-C（r=0.227-0.839,P0.05）. Conclusion IR,AIR and OS coexist in newly-diagnosed type 2 diabetes.Compared with non-obese subjects with 2DM,the obese patients with 2DM have more severe IR and OS,but higher AIR.