【摘要】 目的了解胰岛素敏感性和胰岛β细胞功能在2型糖尿病发病中的作用。方法以静脉葡萄糖耐量试验刺激后急性胰岛素反应(AIR_3-5)表示第一时相胰岛素分泌功能指数,采用口服葡萄糖耐量试验30min 与空腹时胰岛素差值与血糖差值比(ΔI₃₀/ΔG₃₀)反映早期相胰岛素分泌功能;Cederholm 提出的胰岛素敏感性指数（ISI）评估胰岛素敏感性。分析70例非糖尿病者3年追踪结果,其中糖耐量正常（NGT）转变为糖耐量低减（IGT）组（进展 NGT 组）9例,NGT 无进展组45例,IGT逆转为 NGT 组（IGT 好转组）16例。结果（1）AIR_3-5:进展 NGT 组与 NGT 无进展组间基线时比较差异无统计学意义;3年后两组 AIR_3-5均无明显变化,且与基线时比较差异仍无统计学意义;IGT 好转组3年后较基线时升高但差异无统计学意义。（2）ΔI₃₀/ΔG₃₀:进展 NGT 组与 NGT 无进展组间基线时比较差异无统计学意义,3年后两组均无明显变化,组间比较差异仍无统计学意义;IGT 好转组3年后与基线比较差异亦无统计学意义。（3）ISI:基线时进展 NGT 组与 NGT 无进展组间比较差异无统计学意义;3年中进展 NGT 组的 ISI 明显下降,3年后与基线时比差异有统计学意义;而 NGT 无进展组基线时与3年后的 ISI 差异无显著意义。NGT 进展组和 NGT 无进展组间追踪后比较差异有统计学意义。IGT 好转组追踪后 ISI 较基线时明显好转,前后差异有统计学意义。（4）logistic 回归分析显示,AIR_3-5、ΔI₃₀/ΔG₃₀、ISI 3个指标中,仅 ISI 对 NGT 向 IGT 转变的影响有统计学意义。结论本组人群由 NGT 向 IGT 进展过程中,胰岛素敏感性明显下降,而胰岛β细胞功能改变不明显;而由 IGT 逆转为NGT 的过程中,胰岛素敏感性显著改善,而胰岛β细胞功能无明显改变。提示在2型糖尿病发病的早期阶段,即由 NGT 向 IGT 的进展过程中,胰岛素抵抗起主要作用。更多还原

【Abstract】 Objective To investigate the roles of insulin sensitivity and pancreatic beta cell function in the pathogenesis of type 2 diabetes.Methods 70 subjects were recruited in a 3-year prospective study. During this period 9 subjects progressed from normal glucose tolerance（NGT）to impaired glucose tolerance （IGT）（progressing group）,45 remained same（remaining group）and 16 improved from IGT to NGT （improving group）.Acute insulin secretion response（AIR3.5）during intravenous glucose tolerance test （IVGqT）was adopted to indicate the first phase insulin secretion with the ratio of insulin change from 0 min to 30 min to that of blood glucose from 0 min to 30 min(ΔI₃₀/AG₃₀)as the indicator of early insulin secretion and insulin sensitivity（ISI）was analyzed by the formula suggested by Cederholm during oral glucose tolerance（OGTT）.Results（1）For AIR_3-5,there were no differences of the baseline level and the 3-year follow-up state between the progressing group and remaining group;neither there were differences between the baseline level and the 3-year follow-up state in both groups.Meanwhile,in the improving group,AIR_3-5increased after the 3-year follow-up time as compared with that at the baseline,but without significance.（2）For ΔI₃₀/ΔG₃₀,there were no differences of the baseline level and the follow-up state between the progressing group and remaining group;neither there were differences between the progressing group and remaining group baseline level and the 3-year follow-up state in both groups.Meanwhile,in the improving group,there was no difference between that at baseline and at the follow-up.（3）For ISI, although there was no significant difference between the progressing group and remaining group at the baseline level,yet that at the 3-year follow-up state was different between the progressing group and remaining group with ISI in the progressing group decreased significantly;ISI in improving group increased significantly at the 3-year follow-up state as compared with that at the baseline level and there was significant difference between that in progressing group and remaining group at the 3-year follow-up state.（4）Only ISI, but neither AIR_3-5nor ΔI₃₀/ΔG₃₀,had effect on the change of glucose tolerance by logistic regressive analysis.Conclusions The ISI was the main change during the progress of NGT to IGT and the improvement of IGT to NGT,indicating that during the early progressive stage of type 2 diabetes,insulin sensitivity（insulin resistance）may play an important role.更多还原