糖尿病前期胰岛β细胞早期功能缺陷的影响因素研究

Study on influencing factors of beta cell early stage dysfunction in pre-diabetes

目的:研究糖尿病前期肥胖、血脂、年龄等因素对β细胞早期功能缺陷的影响。方法:随机选取符合研究条件的糖调节受损(IGR)受试者37例,以42例2型糖尿病(T2DM)做对照组。进行体重指数(BMI)、甘油三酯(TG)等一般项目及评估,采用标准馒头餐试验,评估受试者空腹及进餐后30、60、120、180 min胰岛素和C肽分泌量、峰值时间。以稳态模型胰岛素抵抗指数(HOMA-IR)及松田指数(Matsuda)评估胰岛素敏感性。以稳态模型β细胞分泌功能指数(HOMA-β)、胰岛素曲线下面积/葡萄糖曲线下面积(AUCI/AUCG)评价β细胞功能。结果:IGR组BMI、TG、Matsuda指数、HOMA-β、AUCI/AUCG结果高于T2DM组,HOMA-IR低于T2DM组(P<0.05);IGR组BMI和TG与β细胞空腹、晚时相分泌正相关,与β细胞分泌高峰的时间正相关,与HOMA-IR正相关(P<0.05),与Matsuda指数负相关(P<0.05),且IGR组年龄与HOMA-β、AUCI/AUCG明显负相关(P<0.05)。控制BMI及TG两个因素后,年龄仍与HOMA-β、AUCI/AUCG负相关(P<0.05);IGR和T2DM组BMI均与β细胞HOMA-β、AUCI/AUCG两项功能指数正相关(P<0.05);IGR肥胖组TG、晚时相胰岛素分泌值及胰岛素分泌峰值时间、β细胞分泌指数AUCI/AUCG指数均大于非肥胖组(P<0.05),胰岛素抵抗指数Matsuda小于非肥胖组(P<0.05)。结论:BMI、TG水平升高,年龄增长是影响IGR阶段β细胞早期功能缺陷的重要因素,尤其BMI、TG与IGR阶段的相关性大于T2DM,应糖尿病前期干预、控制及治疗。

Objective To study the effects of obesity,blood lipids,age,and other factors on early functional defects ofβ-cells in pre-diabetes.Methods Thirty-seven IGR subjects who met the study criteria were selected as the IGR group,and 42 T2DM subjects were used as the control group.General items such as BMI and TG were evaluated.Standard steamed bread test was used to evaluate the subjects'fasting,30 min,60 min,120 min,180 min of insulin,C-peptide secretion and peak time.HOMA-IR index and Matsuda index were used to evaluate insulin sensitivity.HOMA-βand AUCI/AUCG was used to evaluateβ-cell function.Results The results of BMI,TG,Matsuda index,HOMA-βand AUCI/AUCG in IGR group were higher than those in T2DM group,and HOMA-IR was lower than those in T2DM group(P<0.05).BMI and TG in IGR group were positively correlated with fasting and late phase secretion ofβ-cells,time of peak secretion ofβ-cells,and HOMA-IR(P<0.05),while negatively correlated with Matsuda index(P<0.05).Ages in IGR group was significantly correlated with HOMA-βand AUCI/AUCG(P<0.05).After controlling for BMI and TG,age was still associated with HOMA-βand AUCI/AUCG(P<0.05);BMI in IGR and T2DM groups were positively correlated withβ-cell HOMA-βand AUCI/AUCG functional indexes(P<0.05);TG late-phase insulin secretion value and peak time of insulin secretion andβ-cell secretion index AUCI/AUCG index in IGR obese group were higher than those in non-obese group(P<0.05),and insulin resistance index Matsuda was lower than those in the non-obese group(P<0.05).ConclusionBMI and TG and age increase are important factors affecting the early function deficiency ofβ-cells in the IGR stage,and it should be intervened,controlled and treated in pre-diabetes.