新诊断酮症倾向2型糖尿病患者临床特点及胰岛素抵抗分析

Clinical Characteristics and Insulin Resistance Analysis of Newly Diagnosed Patients With Ketosis- prone Type- 2 Diabetes

目的分析新诊断酮症倾向2型糖尿病（KPD）患者的临床特点及其胰岛素抵抗程度。方法选取2010年1月—2014年1月新疆医科大学第一附属医院内分泌科收治住院的新诊断2型糖尿病（T2DM）患者327例,其中KPD患者（KPD组）211例,无酮症倾向T2DM患者（T2DM组）116例,比较并分析两组患者临床特点及胰岛素抵抗相关指标。结果 KPD组患者男性比例、糖化血红蛋白（Hb A1c）、餐后2 h血糖（2 h PPG）、总胆固醇（TC）、Ty G2及糖尿病周围神经病变患病率高于T2DM组（P〈0.05）;KPD组患者年龄小于T2DM组（P〈0.05）。T2DM组20~40岁患者36例,占31.0%;KPD组20~40岁患者114例,占54.0%。KPD组20~40岁患者Hb A1c水平、Ty G、Ty G2、log〔三酰甘油（TG）/高密度脂蛋白胆固醇（HDL-C）〕高于T2DM组（P〈0.05）。KPD组男性患者年龄、餐后2 h胰岛素（2 h PINS）低于T2DM组,TC、Ty G2、log（TG/HDL-C）及糖尿病周围神经病变患病率高于T2DM组（P〈0.05）。KPD组女性患者腰臀比、Hb A1c水平、糖尿病周围神经病变患病率高于T2DM组（P〈0.05）。结论在新诊断T2DM患者中,KPD患者较无酮症倾向T2DM患者发病早、2 h PPG水平更高、血脂紊乱更明显;在新诊断T2DM青壮年（20~40岁）患者中,KPD患者较无酮症倾向T2DM患者存在更严重的胰岛素抵抗;并且男性中KPD患者较无酮症倾向T2DM患者存在更严重的胰岛素抵抗,但女性患者的胰岛素抵抗无明显差异。

Objective To investigate the clinical characteristics of newly diagnosed patients with ketosis - prone type-2 diabetes（ KPD）and analyze the degree of insulin resistance. Methods Enrolled 327 newly diagnosed patients with type 2 diabetes mellitus（T2DM）who received treatment in the Department of Endocrinology of the First Affiliated Hospital of Xinjiang Medical University from January 2010 to January 2014. We assigned 211 KPD patients into KPD group and 116 non -ketosis T2DM patients into T2DM group. Comparison was made between the two groups in clinical features and the relevant indexes of insulin resistance. Results KPD group was higher（P〈0. 05）than T2DM group in male ratio,HbA1c,2 hPPG,TC,TyG2 and the prevalence of diabetic peripheral neuropathy;KPD group was lower（P 〈0. 05）than T2DM group in age. In T2DM group,there were 36 patients aged 20-40,accounting for 31. 0%;in KPD group,there were 114 patients were aged 20-40, accounting for 54. 0%. KPD group was higher（P〈0. 05）than T2DM group in HbA1c,TyG,TyG2 and log（TG/HDL-C）of patients aged 20-40. KPD group was lower（P 〈0. 05）in the age and 2 hPINS and higher（P 〈0. 05）in the TC,TyG2, log（TG/HDL-C）and the prevalence of diabetic peripheral neuropathy than T2DM group of male patients. KPD group was higher（ P 〈 0. 05 ） than T2DM group in WHR, HbA1c and the prevalence of diabetic peripheral neuropathy of female patients. Conclusion Among patients with newly diagnosed T2DM,KPD patients have younger age of onset,higher 2 hPPG level,and more obvious lipid disorder than those non-ketotic T2DM patients. Among patients with newly diagnosed T2DM agednbsp;20-40,KPD patients have more serious insulin resistance than that of non-ketotic T2DM patients,and the case is more serious among male patients and is not significant among female patients.