不同糖耐量人群胰岛功能、胰岛素抵抗状态与瘦素的关系

Relationship between serum leptin and insulin resistance,islet β-cell secretory function among groups of IGT,FAT and normal controls

目的 研究糖耐量正常、单纯肥胖、糖耐量减低人群的胰岛功能、胰岛素抵抗状态 ,及其与血清瘦素水平的关系。方法 采用检测胰岛素敏感性的指标李光伟指数 (IAI)、Homa胰岛素抵抗指数 (IR)和反映胰岛 β细胞功能的指标空腹 β细胞功能指数 (FBCI)、Homaβ细胞功能指数 (HBCI)分别检测成年男性 :11例正常对照 (NGT )、8例单纯肥胖(FAT)、10例糖耐量异常 (IGT)的胰岛素敏感性和 β细胞分泌功能。用放射免疫法测定三组的血清瘦素水平。结果 ①IGT组与NGT组比较IAI、IR、HBCI差异均有显著性。IGT组IAI、HBCI较NGT组降低、IR升高 (P <0 0 5 ) ,而FBCI和血清瘦素水平则无统计学意义。②FAT组与NGT组比较IAI、IR、FBCI和血清瘦素水平差异有显著性。IAI较正常对照组降低 (P <0 0 1) ,IR、FBCI和血清瘦素水平则升高 (P <0 0 1;P <0 0 5 ;P <0 0 1)。③IGT组与FAT组比较IAI、IR差异无显著性 ,但HBCI和FBCI及血清瘦素差异均有显著性意义。FAT组HBCI、FBCI及瘦素较IGT组增高 (P <0 0 5 )。④逐步多元线性回归分析显示控制年龄、体重等因素后 ,腰臀比是影响IAI的独立危险预测因子。血清瘦素水平是影响胰岛细胞分泌功能的独立因素。结论 ①单纯肥胖和糖耐量异常人群与正常人群比较存在明显的胰岛素抵抗 ,胰岛?

Ojective To investigate the states of insulin resistance and islet β-cell secretory function among three groups of impaired glucose tolerance, obese with normal glucose tolerance and normal controls; and to evaluate the relationship between serum leptin and insulin resistance , islet β-cell secretory function.Methods Li Guang Wei insulin action index (IAI), Homa model insulin resistance index (IR) were calculated to evaluate the states of insulin resistance while Homa β-cell function index (HBCI) and fasting β-cell function index (FBCI) were calculated to evaluate the functions of islet β-cell secretion in 10 subjects with impaired glucose tolerance (IGT) , 8 obese subjects with normal glucose tolerance (FAT) and 11 non-obese subjects with normal glucose tolerance (NGT). The serum leptin concentrations were measured by radioimmunoassay (RIA). Results ①There were significant differences in IAI, IR, HBCI between IGT and NGT groups. IAI, HBCI were significantly lower while IR was significantly higher (P<0.05) in IGT group than in NGT group. But FBCI and serum leptin concentrations were not statistically different between IGT and NGT groups. ②There were significant differences in IAI, IR, FBCI and serum leptin concentrations between FAT and NGT groups. IAI was significantly lower(P<0.01)while IR, FBCI and serum leptin levels were significantly higher (P<0.01;P<0.05;P< 0.01) in FAT than in NGT group. ③ There were no significant differences in IAI and IR while there were significant differences in HBCI, FBCI and serum leptin between IGT and FAT groups. HBCI, FBCI and serum leptin were significantly higher in FAT than in IGT group (P<0.05). ④After controlling age, weight etc, stepwise multiple linear regression analysis suggested independent risk predictors for worsening insulin sensitivity was WHR ,and serum leptin for worsening β-cell function. Conclusions ①There was significant insulin resistance (insulin sensitivity was lower) in obese subjects with normal glucose tolerance and impaired glucose tolerance subjects than in controls. ② The β-cell secretory function was significantly increased in FAT while significantly decreased in IGT than in normal controls. ③WHR was an independent predictor for worsening IAI while serum leptin was a factor for worsening β-cell function.