老年正常糖耐量人群3年转归以及胰岛素抵抗与铁蛋白水平的关系

Results of elderly normal glucose tolerance people and the relationship between insulin resistance and serum ferritin after 3 years follow-up

目的探讨老年正常糖耐量人群铁蛋白水平与胰岛素敏感性、胰岛8细胞功能之间的相互作用对其发生糖耐量异常的影响。方法入选上海市闵行区江川社区60岁以上正常糖耐量老年人群2005例，对所有患者进行3年随访，检测基线总胆固醇（TC）、甘油三酯（TG）、空腹血糖（FPG）、餐后2小时血糖（2hPG）、空腹胰岛素（FINS）及血清肌酐（cr）水平，并于3年后随访患者糖代谢及血清铁蛋白（SF）等水平，采用稳态模型的胰岛素抵抗指数（HOMA-IR）、定量胰岛素敏感性指数（QUICKI）评估胰岛素抵抗；采用处置指数（DI）评估胰岛β细胞功能。结果3年后49．3％的老年正常糖耐量人群进展为糖尿病前期（IGR）、9．5％进展为2型糖尿病（T2DM），与基线相比，随访后LnHOMA-IR升高，LnQUICKI及LnDI下降（P〈0．05），并且随着糖代谢紊乱的加重，LnSF逐渐升高（P〈0．05）；3年随访后，Spearman相关性分析示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，老年正常糖耐量女性人群3年后LnSF与LnHOMA—IR呈独立正相关（P〈0．05），男性人群LnSF与LnFINS呈独立正相关（P〈0．05）。结论随着年龄的增长，胰岛素抵抗与铁超载的相互促进作用可能是老年正常糖耐量人群进展为糖耐量异常的一个重要病因。

Objective To explore effect of glucometabolic state under interaction between serum ferritin and insulin sensitivity,β-cell function in old normal glucose tolerance people after 3 years follow-up. Methods A total 2 005 patients with normal glucose tolerance （NGT） who lived in Shanghai Jiangchuan Community were enrolled in this study. Total cholesterol （ TE ）, triglyceride （TG）, fasting plasma glucose （FPG） ,2 hour postprandial glucose （2h PG）, fasting insulin （FINS） and serum ereatinine （Cr） were measured in baseline. Indexes of glucose metabolism and serum ferritin（SF） were evaluated after 3 years. Homeostasis model assessment of insulin resistance（HOMA-IR） and Quantitative insulin sensitivity check index（QUICKI） index were used to estimate insulin resistance, and disposition index（DI） to evaluate β-cell function. Results In subjects with NGT, 49.3% participants developed into impaired glucose regulation（IGR） and 9.5% developed into type 2 diabetes mellitus at follow-up. LnHOMA-IR of follow-up were higher while LnQUICK and LnDI were lower than those of baseline group （ P 〈 0.05 ）. Meanwhile, accompany by the degree of glucose metabolism dysfunction increased, the level of LnSF elevated. After 3 years follow-up, Spearman analysis showed that LnSF was positively associated with LnHOMA-IR and negatively correlated to LnQUCIK and LNDI （ P 〈 0. 05 ）. Multiple stepwise regression showed that the LnSF was dependently positive related to LnHOMA-IR in women （ P 〈 0.05 ） and positive related with LnFINS in men（P 〈 0.05 ）. Conclusion With aging,it may be one important reason that mutual impetus between iron overload and insulin resistance from NGT progression to impaired glucose metabolism people.