两种标准诊断的糖尿病前期胰岛素抵抗和胰岛功能的比较研究

A comparative analysis of insulin resistance and pancreatic β-cell function in patients with prediabetes diagnosed by two different criteria

目的比较美国糖尿病学会(ADA)新建议的糖化血红蛋白(HbA1c)标准和经典的口服糖耐量试验(OGTT)标准诊断的糖尿病前期(PDM)人群胰岛素参数变化的特点,从糖尿病发病机制的角度验证HbA1c标准在中国人群中的适用性。方法对2011年1月至12月参加健康体检的497名广州籍汉族人进行口服葡萄糖耐量试验(OGTT)和HbA1c、空腹胰岛素(Fins)、服糖后2小时胰岛素(2hIns)参数检测,计算稳态模型评估的胰岛素抵抗指数(HOMA-IR)和β细胞功能指数(HOMA-β)、矫正的HOMA-β。分别对HbA1c标准与OGTT标准所定义的PDM组和正常糖耐量(NGT)组的各胰岛素指数水平进行统计学分析。结果 HbA1c标准诊断时,PDM组Fins[中位数(四分位数间距),下同:5.77(5.37)对4.64(3.63)]、2hIns[(均值±标准差,下同:1.30±0.36对1.22±0.31)、HOMA-IR[1.40(1.28)对1.07(0.91)]水平明显高于NGT组(P<0.05),矫正后的HOMA-β[43.5(20.2)对50.7(20.7)]水平明显低于NGT组(P<0.05)。两种标准同时诊断时,与两种标准都诊断为NGT组相比,两种标准都诊断为PDM组Fins[6.36(5.17)对4.82(3.33)]、2hIns(1.40±0.35对1.16±0.29)、HOMA-IR[1.56(1.27)对1.06(0.82)]水平明显升高(P<0.05)而矫正后的HOMA-β[36.1(9.3)对57.5(20.8)]水平明显降低(P<0.05),单独OGTT诊断的PDM组2hIns明显升高(1.32±0.33对1.16±0.29,P<0.05)、矫正后的HOMA-β明显降低[39.8(14.4)对57.5(20.8),P<0.05],单独HbA1c诊断的PDM组各参数均无统计学差异(P>0.05)。结论 OGTT标准依然是能够正确检出具有胰岛素抵抗和/或胰岛素分泌功能减退的PDM的金标准。ADA推荐的HbA1c标准所诊断的PDM总体上存在胰岛素抵抗及胰岛β细胞功能受损,是筛查PDM合理的选项之一。

Objective To compare the indexes of serum insulin between prediabetes （PDM） patients diagnosed by the new HbA1c-based criteria that proposed by American Diabetes Association（ADA） and the classic oral glucose tolerance test（OGTl＇） cri- teria, and validate the applicability of HbA1c-based criteria for Chinese people from the pathophysiological mechanism of diabetes. Methods From January to December in 2011,497 healthy Han people in Guangzhou were enrolled to detect OGTT, as well as HbA1c, serum fasting insulin（Fins） and insulin 2 hours after taking sugar （2hlns）. Other insulin indexes such as homeostasis model assessment for insulin resistance index （HOMA-IR）, β-cell function index （HOMA-β） and corrective HOMA-β were computed for statistical analyses. Results By HbA1c-based criteria, levels of Fins [median （quartile range）：5.77 （5.37） vs 4.64 （3.63）], 2hIns （mean＋SD：1.30±0.36 vs 1.22＋0.31）, HOMA-IR[1.40（1.28） vs 1.07（0.91）]were statistically higher in PDM group than those in NGT group（P〈0.05） , while the level of corrective HOMA-β was statistically lower[43.5（20.2） vs 50.7（20.7）]（P〈0.05）. Compared with those in the NGT group meeting beth HbAlc-based criteria and OGTr-based criteria, PDM group meeting beth criteria had sta- tistically higher levels of Fins [6.36（5.17） vs 4.82（3.33）], 2bins （1.40x＇-0.35 vs 1.16：L-0.29）and HOMA-IR [1.56（1.27） vs 1.06（0.82）] but lower level of corrective HOMA-13136.1（9.3）vs57.5（20.8）]（P〈0.05）. Similarly, the PDM group meeting only OGTr-based criteria had statistically higher 2hlns（1.32x-0.33 vs 1.16＋0.29）and lower corrective HOMA-β139.8（14.4） vs 57.5（20.8）]（P〈0.05）. But no sta- tistical difference was found for all the insulin indexes between the PDM mroup meetina only HbA,o-based criteria and the NGT group meeting both criteria. Conclusions OGTT-based cri- teria is always the gold standard for correctively identifying PDM with insulin resistance and/or insulin secretion defi- ciency. HbAic-based criteria proposed by ADA is one of available options in screening PDM since patients with prediabetes diagnosed, these patients generally have insulin resistance and impaired pancreatic β-cell function.