非糖尿病患者胰岛β细胞功能减退的因素分析

A correlative study of β cell hypofunction and the related factors in non-diabetic patients

目的探讨非糖尿病患者胰岛β细胞功能减退的特点及其相关因素的影响。方法选择非糖尿病患者378例[存在下列指标中的任何一项异常：肥胖、血压、血脂、尿酸、C反应蛋白（CRP）、纤维蛋白原（FIB）、甲状腺功能、同型半胱氨酸（Hcy）、脂肪肝、焦虑状态]和健康体检者50例（健康对照），检测或计算血压、体质指数（BMI）、腰臀比、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）、尿酸、CRP、FIB、甲状腺功能、Hcy；标准馒头餐试验检测胰岛素、血糖，计算稳态模型评估法胰岛β细胞功能指数（HOMA-β）、经胰岛素抵抗指数校正的糖负荷后30min胰岛素净增值／葡萄糖净增值[（△I30/△G30）/IR]、经胰岛素抵抗指数校正的糖负荷后120min胰岛素净增值／葡萄糖净增值[（△I120/△G120）／IR]和修正胰岛β细胞功能指数（MBCI）；行腹部B超检查观察有无脂肪肝；行修订状态．特质焦虑问卷调查有无焦虑状态。结果高收缩压、高TG、甲状腺功能亢进（甲亢）、高腰臀比患者（△I30/△G30）/IR低于健康对照者（14．24±10．25、13．58±9．14、13．45±9．89、13．71±9．67比20．72±17．03），高TG患者HOMA-β高于健康对照者（5．87±1．37比4．91±1．75），差异均有统计学意义（P〈0．05）。早相胰岛B细胞功能受损[（△I30/△G30）／IR〈15．78，166例]患者收缩压、TG、腰臀比、甲亢程度[促甲状腺素（TSH）]与早相胰岛β细胞功能正常[（△I30/△G30）/IR≥15．78，262例]患者比较差异有统计学意义[（163．50±10．92）mmHg（1mmHg=0．133kPa）比（136．40±11．47）mmHg、（2．23±0．69）mmol／L比（1．42±0．53）mmol/L、1．00±0．08比0．81±0．06、（0．29±0．22）mU／L比（3．26±1．37）mU／L，P〈0．05]。多因素Logistic回归分析结果显示腰臀比、TG、收缩压、甲亢程度（TSH）为早相胰岛β细胞功能的独立影响因素（P〈0．05或〈0．01）。糖耐量异常患者（45例）MBCI、（△I30/△G30）／IR明显低于健康对照者（5．87±2．91比7．42±3．39、12．09±10．56比20．72±17．03），差异有统计学意义（P〈0．05）；空腹血糖受损患者（47例）HOMA-β低于健康对照者（4．25±1．22比4．91±1．75），差异有统计学意义（P〈0．05）；三者（△I120/△G120）/IR比较差异无统计学意义（P〉0．05）。结论腰臀比、TG、收缩压、甲亢程度等为独立影响早相胰岛β细胞功能的因素。对其相关因素进行干预治疗，早相胰岛β细胞功能会有所改善。

Objective To study the characteristics and influencing factors of β cell hypofunction in non-diabetic patients. Methods Three hundred and seventy-eight cases of non-diabetic patients （who hadone abnormal index in the following：obesity, blood pressure, blood lipid, uric acid, C reactive protein （CRP）, fibrinogen （FIB）, thyroid function, homocysteine （Hcy）,fatty liver, anxiety） and 50 cases of healthy people were selected. Blood pressure, body mass index （BMI）,waist-hip ratio,triglycerides （TG）, low density lipoprotein cholesterol （LDL-C）, uric acid, CRP, FIB, thyroid function and Hcy was recorded. Through steamed bread meal test, blood glucose and insulin was recorded. The figures inclued homeostasis model assessment model β -cell function index（HOMA-β）,early-phase insulin secretion[ （ △I30/△G30）/IR], second-phase secretion [（ △I120/△G120）/IR] and corrected human βcell function index （MBCI） were calculated. The fatty liver could be found by B ultrasound. All subjects completed tests of the State-Trait Anxiety Inventory-From Y questionnaire. Results The （△I30/△G30）/IR of patients with elevated systolic blood pressure （SBP）, elevated TG, hyperthyroidism （TSH） and high waist-hip ratio was lower than that in healthy people （ 14.24 ± 10.25,13.58 ± 9.14, 13.45 ± 9.89, 13.71 ± 9.67 vs. 20.72 ± 17.03,P 〈 0.05）. The HOMA- β of patients with elevated TG was lower than that in healthy people （5.87 ± 1.37 vs. 4.91 ± 1.75 ）. The levels of SBP, TG, waist-hip ratio and TSH in patients with β eell hypofunction [ （△I30/△G30）/IR 〈 15.78,166 cases] showed significant difference compared with that in patients with β cell normal function [ （ △I30/△G30）/IR≥ 15.78,262 cases][ （ 163.50 ± 10.92） mm Hg （ 1 mm Hg = 0.β3 kPa） vs. （ β6.40±11.47 ） mm Hg, （2.23 ± 0.69 ） mmol/L vs. （ 1.42 ± 0.53 ） mmol/L, 1.00 ± 0.08 vs. 0.81 ± 0.06, （0.29± 0.22） mU/L vs. （3.26± 1.37 ） mU/L, P 〈 0.05 ]. Logistic regression analysis showed that the levels of waist-hip ratio,TG,SBP and TSH were independent factors to affect early insulin secretion function factors （P 〈 0.05 or 〈 0.01 ）. The MBCI and（ △I30/△G30）/IR in impaired glucose tolerance patients （45 cases） was significantly lower than that in healthy people （5.87 ± 2.91 vs. 7.42 ± 3.39,12.09 ± 10.56 vs. 20.72 ± 17.03 ,P 〈 0.05）. The HOMA- β in impaired fasting glucose patients （47 cases） was lower than that in healthy people （4.25 ± 1.22 vs. 4.91 ± 1.75,P 〈 0.05）. There was no significant difference in（ △I120/△G120）/IR among them （P 〉 0.05 ）. Conehmions The levels of waist-hip ratio ,TG,SBP and hyperthyroidism may be the independent factors to affect early insulin secretion function. After the intervention of influencing factors, early insulin secretion function is improved.