2型糖尿病患者高胰岛素血症变化的研究

Study of hyperinsulinism progression in patients with type 2 diabetes mellitus

目的探讨2型糖尿病(T2DM)不同发展阶段高胰岛素血症(HINS)的变化情况。方法分别检测38例T2DM前期、52例新确诊、92例有T2DM病史患者(按病程分为0.5～3年、4～7年和8～11年)及20名正常对照者糖化血红蛋白(HbA1c)、血糖、胰岛素、C肽等指标,并采用从www.ocdem.ox.ac.uk下载的HOMA2计算器(V2.2)计算胰岛素抵抗指数(HOMA2-IR)和胰岛素分泌指数(HOMA2-%β)。结果 T2DM各组胰岛素分泌高峰出现在2 h,均呈现胰岛素分泌延迟现象;T2DM前期组和新确诊组口服葡糖糖耐量试验(OGTT)2 h胰岛素均值高于HINS诊断标准,且HINS患者分别占各组的50.00%和48.10%;随着病程的增长,HINS患者在有0.5～3年、4～7年和8～11年T2DM病史的患者中分别占28.57%、13.89%和10.00%。结论 T2DM前期有相当一部分患者处于HINS状态;随着病程的增长,HINS患者逐渐减少,但仍有部分T2DM患者长期处于HINS状态。

Objective To investigate the progression of hyperinsnlinism（HINS） in different development phases of type 2 diabetes mellitus （T2DM）. Methods A total of 38 pre-T2DM patients ,52 newly diagnosed T2DM patients and 92 patients who had T2DM history were enrolled. According to the course of T2DM ,the patients with T2DM history were classified into 3 groups： 0. 5-3 years, 4-7 years and 8-11 years, and 20 healthy subjects were as controls. The glycosylated hemoglobin （HbAlc） ,blood glucose, insulin and C peptide were determined. Homeostasis model of insulin resistance index （HOMA2-IR） and secretion function index （ HOMA2-% β） were calculated by HOMA2 calculator （ V2.2 ） downloaded from www. ocdem, ox. ac. uk. Results All T2DM groups＇ secretion peaks appeared in 2 h of oral glucose tolerance test（ OGTr）, and all presented secretion delay. The 2 h insulin levels of the pre-T2DM and newly diagnosed T2DM groups were higher than HINS diagnosis standard, and the HINS patients accounted for 50.00% and 48.10%, respectively. With the increasing of T2DM course, the proportions of HINS patients in the T2DM history group were 28.57%, 13.89% and 10.00%, respectively. Conclusions There is a proportion of pre-T2DM patients with HINS, and with the increasing of T2DM course, the proportion of HINS patients reduces,but HINS still exists in patients with long history of T2DM.