老年正常糖耐量代谢紊乱集簇铁蛋白水平与胰岛素抵抗和胰岛β功能相关性研究

The relationship between serum ferritin and insulin resistance β-cell function in old normal glucose tolerance people with the clustering of metabolic risk factors

目的 探讨老年正常糖耐量人群代谢紊乱集簇铁蛋白水平与胰岛素抵抗和胰岛β细胞功能之间的关系.方法 入选上海市江川社区＞60岁老年人4 330例,其中2型糖尿病组（T2DM）1 143例、糖尿病前期组（IGR） 237例及正常糖耐量组（NGT）2 950例.测定其血压、血脂、空腹血糖（FBG）、2小时血糖（2hBG）、空腹胰岛素（FINS）和血清铁蛋白（SF）水平.采用HOMA-IR、QUICK评估胰岛素抵抗;采用HOMA-β和处置指数（DI）评估胰岛β细胞功能.根据代谢综合征（MS）诊断标准将正常糖耐量组分为无代谢紊乱数目组（NMS0）、1种代谢紊乱数目组（NMS1）、2种代谢紊乱数目组（NMS2）、3种代谢紊乱数目组（NMS3）和4种代谢紊乱数目组（NMS4）.非正态资料进行自然对数（LN）转换.结果 老年正常糖耐量人群随着代谢紊乱数目集簇,LNHOMA-IR和LNSF呈逐渐升高趋势（P＜0.05）;LNQUICK和LNDI呈逐渐下降趋势（P＜0.05）.同时,随着SF水平升高,LNHOMA-IR逐渐加重,LNDI逐渐下降.Spearman相关分析显示老年正常糖耐量人群LNSF与HOMA-IR呈正相关,与LNQUICK和LNDI呈负相关（P＜0.05）.多元逐步回归分析显示,老年正常糖耐量LNSF与LNHOMA-IR呈独立正相关（P＜0.05）.结论 老年正常糖耐量人群随着代谢紊乱数目集簇,SF水平逐渐升高,胰岛素抵抗逐步加重,胰岛β细胞功能逐步减退.铁超载与胰岛素抵抗密切相关.

Objective To explore relationship between serum ferritin and insulin resistance,β-cell function in older normal glucose tolerance （NGT） people with the clustering of metabolic risk factors. Methods 1143 patients with type 2 diabetes（T2DM） ,237 impaired fasting glucose（IGR） and 2 950 NGT subjects who lived in Shanghai Jiangchuan Community were enrolled this study. Blood pressure, Lipid, fasting blood glucose （ FBG）, 2 hour postprandial glucose （ 2hBG）, fasting insulin （FINS） and serum ferritin（SF） were measured. Homeostasis model assessment of insulin resistance （HOMA-IR）and QUICK index were used to estimate insulin resistance,and HOMA-~ and disposition index（DI） to evaluate β-cell function. Metabolic syndrome（MS） was defined based on the Chinese Diabetes Session（CDS） criteria in 2004 years. Results were analyzed to the serum ferritin effected on insulin resistance and β-cell function,according to different number of metabolic disorder. Results The levels of LNHOMA-IR and LNSF increased and LNQUICK and LNDI decreased step by step accompany by the number of metabolic disorder risk factors increased in NGT group（P 〈 0.05）. Meanwhile, accompany by the level of LNSF in- creased,the level of LNHOMA-IR elevated and LNDI reduced. Spearman analysis showed that LNSF was positively associated with LNHOMA-IR and negatively correlated to LNQUCIK and LNDI in NGT group. Stepwise Regression showed that the LNSF was dependently positive related to LNHOMA-IR in NGT group （ P 〈 0.05 ）. Conclusion The result suggested that the level of LNSF, insulin resistance increased and β-cell secretion decreased step by step accompany by the clustering of metabolic risk factors. The exist- ence of iron overload was significantly related to insulin resistance in older Chinese people with normal glucose tolerance.