中国人糖耐量异常与胰岛素抵抗和胰岛素分泌

摘要

目的研究胰岛素抵抗和胰岛素分泌缺陷与中国人糖耐量变化的关系。方法对466例(正常体重189例，超重／肥胖277例)正常糖耐量(NGT)、糖耐量减退／空腹血糖减损(IGT／IFG)、2型糖尿病(DM)患者，用稳态模式评估法(HOMA)评价胰岛素抵抗(HOMA-IR)及胰岛β细胞基础功能(HOMA-βcell)，并用糖负荷30分钟净增胰岛素／净增葡萄糖(△I30／△G30)比值评价早期胰岛素分泌反应。结果校正年龄、性别、体重指数(BMI)、体脂分布(腹内脂肪、腹部及股部皮下脂肪面积)和血压等因素后，无论有无超重／肥胖，IGT／IFG、DM患者胰岛素抵抗指数显著升高，超重／肥胖者尤为明显。并有胰岛β细胞基础功能及早期胰岛素分泌反应降低，DM患者更显著。结论中国人从正常糖耐量到糖耐量异常的变化过程中，胰岛素抵抗和胰岛素分泌功能减退起共同作用。%Objective To investigate the impact of insulin resistance and insulin secretion on the development of glucose intolerance in Chinese. Methods Given 75-gram oral glucose tolerance challenge, 466 Chinese (189 normal weight, 277 overweight/obesity) were divided into normal glucose tolerance (NGT) group, impaired glucose tolerance/impaired fasting glucose (IGT/IFG) group, as well as type 2 diabetes (DM) group according to 1997 ADA criteria.Homeostasis model assessment (HOMA) was applied to assess the status of insulin resistance (HOMA-IR) and basic function of pancreatic β cell (HOMA-β cell). While insulinogenic index (the ratio of the increment of insulin to that of plasma glucose 30 min after a glucose load, △I30/△G30) was performed to evaluate the early phase insulin secretion.Results Adjusted with age, sex, body mass index (BMI), body fat distribution indices (including abdominal visceral,subcutaneous, and femoral subcutaneous adipose tissue areas) and blood pressure, our data indicated that in comparison with NGT group, HOMA-IR wIR increased significantly in IGT/IFG and DM group, especially overt in the overweight or obesity subjects. Meanwhile HOMA-β cell and△I30/△G30 were remarkably lower in IGT/IFG and DM group than in NGT group, particularly in DM group. Conclusion Insulin resistance and insulin secretion deficiency may play an important role on the worsening from normal glucose tolerance to glucose intolerance in Chinese individuals.