不同糖调节受损人群氧化应激状况与胰岛素抵抗及胰岛β细胞功能的相关性

The association between oxidative stress and insulin resistance and beta cell function on patients with different impaired glucose regulation

目的:探讨不同糖调节受损人群氧化应激状况与胰岛素抵抗(IR)及胰岛β细胞功能的关系。方法:选取正常对照组(NGT)28例、空腹血糖受损组(IFG)30例、糖耐量异常组(IGT)30例及初诊2型糖尿病组(T2DM)32例,测定4组血清丙二醛(MDA)、谷胱甘肽过氧化物酶(GSH-PX)和超氧化物歧化酶(SOD)值,用胰岛素抵抗指数(HOMA-IR)及胰岛β细胞功能指数(HOMA-β)评价IR及胰岛细胞功能,糖负荷后30 min胰岛素分泌指数(△I30/△G30)、李氏β细胞功能指数(MBCI)评价糖负荷后胰岛素分泌功能。结果:从NGT、IFG、IGT到T2DM组血清中MDA水平依次增高,与NGT组差异均有统计学意义(P<0.01);与IFG组比较,IGT组及T2DM组差异均有统计学意义(P<0.01),而IGT组及T2DM 2组间差异无统计学意义(P>0.05)。而从NGT、IFG、IGT到T2DM组血清中SOD、GSH-PX水平逐渐降低,与NGT组比较,T2DM组SOD、GSH-PX差异均有统计学意义(P<0.01);IFG、IGT及T2DM 3组间差异均无统计学意义(P>0.05)。MDA与HOMA-β、△I30/△G30、MBCI均呈负相关关系,而与HOMA-IR呈正相关关系,血清中SOD与HOMA-β、△I30/△G30、MBCI均呈正相关关系,而与HOMA-IR呈负相关关系,GSH-PX活性与HOMA-β、MBCI均呈正相关关系。结论:IR和β细胞功能下降是T2DM发生、发展中重要的病理生理改变,在糖调节受损阶段即已出现,从NGT、IFG、IGT到T2DM组氧化应激水平逐渐升高,在糖调节受损阶段机体的氧化抗氧化平衡系统已经开始发生紊乱,在初诊T2DM患者更为明显,且氧化应激与IR及胰岛β细胞功能密切相关,氧化应激在T2DM起始及发生、发展中可能发挥重要作用。

Objective：To investigate the oxidative stress condition in patients with different impaired glucose regulation and analyzethe relevance of oxidative stress and insulin resistance （IR） and β-cell function. Methods：Twenty-eight patients with normal glucose tolerance （NGT）, 30 with impaired fasting glucose（ IFG）, 30 with impaired glucose tolerance （IGT） and 32 with type 2 diabetes mellitus （T2DM） were observed. The serum SOD, GSH-PX and MDA levels in all cases were measured, with HOMA-IR, HOMA-β, △ I30/△ G30, MBCI respectively to assess IR, the basal insulin secretion, early stage of insulin secretion and insulin secretion after glucose load. Results： Compared to NGT,the serum MDA level was increased from NGT,IFG、IGT toT2DM（P 〈 0.01 ）. Compared to IFG, there was statistical difference in IGT and T2DM（P 〈 0.01 ）. There was no statistical difference between IGT and T2 DM （P 〉 0.05 ）. The serum SOD,GSH-PX levels were decreased from NGT,IFG, IGT to T2DM. There was statistical difference between NGT and T2DM and no statistical difference among IFG, IGT and T2DM. There was positive correlation between MDA and HOMA-IR, between SOD and HOMA-β, △I30/△G30,MBCI,between GSH-PX and HOMA-β, MBCI. There was negative correlation between MDA and HOMA-β, A △I30/△G30, MBCI, between SOD and HOMA-IR. Conclusions： IR and β-cell function decline was important pathophysiological changes in type 2 diabetes mellitus and emerged before th.e diagnosis of diabetes. From NGT,IFG,IGT to T2DM ,the degree of oxidative stress was getting higher and oxidative injury was existed in pre-diabetes mellitus. There was confidential correlation between oxidative stress and IR and β-cell function. Oxidative stress may have an important function with the development of T2DM.