2型糖尿病及前期患者胰岛素抵抗与脂代谢紊乱的关系

Relationship between Insulin Resistance and Dyslipidemia in Patients with Prediabetes and Type 2 Diabetes Mellitus

目的探讨2型糖尿病(T2DM)及其前期患者胰岛素抵抗(IR)与脂代谢紊乱的关系。方法对31例T2DM患者(糖尿病组)、20例糖尿病前期患者(糖尿病前期组)及20例健康对照者(正常对照组)进行口服葡萄糖糖耐量试验、胰岛功能释放试验、血脂谱测定,并计算体质指数(BMI)、腰臀比(WHR),测定空腹C肽及脂代谢指标等。结果 (1)糖尿病组患者的BMI、WHR、空腹C肽水平、胰岛素抵抗指数(HOMA-IR)、三酰甘油(TG)水平均显著高于正常对照组(P<0.05);早期胰岛素分泌指数(EISI)、胰岛素敏感性指数(ISI)、胰岛β细胞功能(HOMA-β)较正常对照组、糖尿病前期组显著降低(P<0.05)。糖尿病前期组患者的BMI、WHR、TG水平显著高于正常对照组(P<0.01)。(2)Pearson相关分析表明:HOMA-IR与BMI、WHR、空腹血糖(FBG)、餐后2 h血糖(2 hPG)、总胆固醇(TC)、TG、极低密度脂蛋白(VLDL)、空腹胰岛素(FINS)、空腹C肽呈正相关(P<0.05)。结论糖尿病前期人群无明显的IR和胰岛β细胞功能衰竭。T2DM及糖尿病前期患者脂代谢紊乱以高TG血症为主要特征;高TG血症反映了糖尿病患者的IR程度。BMI可作为糖尿病及前期患者胰岛功能变化的危险因素。

Objective To investigate the relationship between insulin resistance （IR） and dyslipidemia in prediabetes and type 2 diabetes mellitus （T2DM） patients. Methods Glucose tolerance test, insulin release test, and serum lipid profile determination were carried out in 31 cases of T2DM, 20 cases of prediabetes patients, and 20 cases of healthy controls, with the data of body mass index （BMI）, waist hip ratio （WHR）, fasting C peptide （FC） and lipid metabolism indices obtained at the same time. Results Levels of BMI, WHR, FC, HOMA - IR, and triglycerides （TG） in the T2DM group were higher than those in the control group （P 〈 O. 05 ） ; Early insulin secretion index （ EISI）, insulin sensitivity index （ISI） and pancreatic [5 - cells function index （ HOMA - [3） in the T2DM group were lower than those in the prediabetes group and the control group （ P 〈 0. 05 ） . BMI, WHR and TG in the prediabetes group were higher than those in the control group （P 〈 0. 01 ） . Pearson corre- lation analysis indicated positive correlations between insulin resistance index （ HOMA - IR） and BMI, WHR, fast blood glucose （FBG）, 2 -hour postprandial glucose （2 hPG）, TC, TG, very low density lipoprotein （VLDL）, fasting insulin （ FINS）, and FC （P 〈 0. 05 ） . Conclusion No distinct insulin resistance and failure of islet [5 cells were seen in prediabetes patients. T2DM and prediabetes lipid metabolism disorders are mainly characterized by high TG levels, which reflects the degrees of insulin resistance in these patients. BMI could be regarded as a hazard factor for the decline in islet [5 cell function in prediabetes and T2DM patients.