【摘要】 目的研究胰岛素抵抗(IR)和β细胞功能在2型糖尿病(T2DM)发生、发展过程中的作用。方法在2013年浙江省玉环县健康队列基线调查基础上,选取269名初诊T2DM患者,按照性别相同、年龄差小于3岁且无血缘关系的条件选取糖调节受损(IGR)和正常糖耐量(NGT)各269例。将初诊T2DM亚分类为单纯空腹血糖升高(IFH)、单纯负荷后血糖升高(IPH)和空腹合并负荷后血糖升高(CH),IGR分为单纯空腹血糖受损(IFG)、单纯负荷后血糖受损(IGT)和空腹合并负荷后血糖受损(CGI)。采用稳态模型胰岛素抵抗指数(HOMA-IR)、胰岛β细胞功能指数(HOMA-β)和葡萄糖处置指数(DI)对IR、胰岛β细胞功能和代偿IR的β细胞功能进行评价。结果从NGT到IGR到T2DM,HOMA-IR逐渐增高,而HOMA-β和DI逐渐降低(P<0.05)。调整年龄、性别、肥胖及高血压后,与NGT比较,IFG和CGI的HOMA-IR增高、HOMA-β和DI降低,而IGT仅HOMA-β和DI降低(P<0.05);IFG、CGI较IGT的HOMA-IR升高、HOMA-β和DI降低(P<0.05);IFH、CH较IPH的HOMA-IR升高、HOMA-β和DI降低(P<0.05),CH仅DI低于IFH(P<0.05),且IFH与IFG比较及CH与CGI比较,均为HOMA-IR增高、HOMA-β和DI降低,而IPH仅HOMA-β和DI低于IGT(P<0.05)。多因素线性回归分析显示,HOMA-IR在NGT组对空腹血糖有显著影响(P<0.05),DI在各组对空腹血糖和负荷后血糖均有显著影响(P<0.05)。结论 IFG和CGI主要表现为IR和β细胞功能受损,而IGT则主要表现为β细胞功能受损。空腹血糖升高以基础状态下胰岛β细胞功能受损和IR为主要特征,同时基础状态下胰岛β细胞功能对负荷后血糖有所影响。更多还原

【Abstract】 Objective To assess the possible role of insulin resistance( IR) and βcell function in the pathophysiology of newly diagnosed type 2 diabetics( T2DM).Methods An oral glucose tolerance test was obtained at the health cohort baseline.Subjects with normal glucose tolerance( NGT,n = 269),impaired glucose regulation( IGR,n = 269) and newly diagnosed type 2 diabetics( T2 DM,n = 269) were defined by ADA criteria. Subjects with NGT and IGR were selected from residents living in the same community of diabetic patients with the same gender and age( ± 3 years old). The T2 DM group was sub-classified as isolated fasting hyperglycemia( IFH),isolated post-challenge hyperglycemia( IPH) and combined hyperglycemia( CH). The IGR group was subclassified as impaired fasting glucose( IFG),impaired glucose tolerance( IGT) and combined glucose intolerance( CGI). Homeostasis model assessment of insulin resistance( HOMA-IR),β cell function( HOMA-β) and deposition index( DI) were to evaluate the insulin resistance or sensitivity, islet β cell function and that when insulin compensated respectively. Results From NGT to T2 DM,HOMA-IR increased while HOMA-β and DI decreased significantly( P < 0. 05). After the adjustment of age,gender,obesity and hypertension,IFG and CGI subgroup had statistically higher HOMAIR and lower HOMA-β and DI,and IGT subgroup only had lower HOMA-β and DI than NGT subgroup( P < 0. 05). Compared to IGT subgroup,IFG and CGI subgroup had significantly higher HOMA-IR and lower HOMA-β and DI( P < 0. 05). IFH and CH subgroup had statistically higher HOMA-IR and lower HOMA-β and DI than IFH subgroup( P < 0. 05),DI of CH subgroup significantly decreased than that of IPH subgroup( P <0. 05). IFH and CH subgroup had statistically higher HOMA-IR and lower HOMA-β and DI than IFG and CGI subgroup respectively. HOMA-β and DI decreased of IPH subgroup compared to IGT subgroup,and multiple linear regression analysis showed that HOMA-IR had significant influence on fasting plasma glucose( FPG) in NGT( P < 0. 05),whereas two-hour plasma glucose and FPG were influenced by DI( P < 0. 05) in the progression.Conclusions Both basic β cell dysfunction and IR exist in IFG and CGI,while only basic β cell dysfunction exist in IGT. The basic β cell dysfunction and IR are the primary features of fasting hyperglycemia,and basic β cell dysfunction also contribute to postchallenge hyperglycemia.更多还原