【摘要】 目的　探讨胰岛素抵抗（ＩＲ）和胰岛细胞功能障碍在２ 型糖尿病（ＤＭ） 发病中的作用。方法　２ 型ＤＭ 家系中，对部分成员进行口服葡萄糖耐量试验（ＯＧＴＴ），按ＷＨＯ 标准将家系成员分为ＤＭ 一级亲属正常组（１０６ 例） ，糖耐量低减组（ＩＧＴ） 组（３９ 例） ，新诊断ＤＭ 组（６３ 例） 和原诊断ＤＭ组（８３ 例，病程１ 年以上） ，计算各组成员的胰岛素敏感性指数（ＩＳＩ） 以及胰岛初期分泌功能指数（简称分泌指数），并与无ＤＭ 家族史的健康人（５３ 例） 相比较。结果　家系各组成员空腹血浆胰岛素（ＦＩＮＳ） 水平显著高于正常对照组（ Ｐ＜ ０ ．０５） ，ＩＳＩ显著低于正常对照组（ Ｐ＜ ０．０１）。一级亲属各组糖负荷后３０ 分钟的血浆胰岛素（ＩＮＳ） 水平以及分泌指数显著高于正常对照组和ＤＭ 组（Ｐ＜ ０ ．０１）。新诊断与原诊断ＤＭ 组ＩＳＩ显著低于其余三组，同时，分泌指数显著低于正常对照组、一级亲属正常组及ＩＧＴ 组。原诊断ＤＭ 组在ＯＧＴＴ 餐后各时相的ＩＮＳ水平均显著低于家系中的其余三组。结论　２型ＤＭ 家系中，各类成员均存在高胰岛素血症，一级亲属胰岛β细胞初期分泌功能代偿性增强，以维持正常的糖耐量。ＩＧＴ患者胰岛初期代偿分泌功能受?更多还原

【Abstract】 Objective To investigate the role of insulin resistance and islet dysfunction in the pathogenesis of type 2 diabetes mellitus. Methods Oral glucose tolerance test (OGTT) was conducted in type 2 diabetic pedigrees which consisted of 63 newly diagnosed diabetic patients, 83 diabetic patients diagnosed over 1 year (previously diagnosed diabetic patients), their 106 non diabetic first degree relatives, and 39 patients with impaired glucose tolerance (IGT). 53 healthy subjects without family history of diabetes and hypertension served as the normal controls. Insulin sensitivity index (ISI) and the early stage secretion index of islet β cell (secretion index) were calculated in all subjects. Results The fasting plasma insulin (FINS) was higher (P<0.05) and ISI was lower in pedigrees (P<0.01). Secretion index of first degree relatives increased singnificantly as compared with the other four groups (P<0.01). In both of the two diabetes groups, ISI were lower than those in the other three groups, and secretion indices were lower than normal controls and first degree relatives (P<0.05). Besides, plasma insulin levels after glucose administration at all phases of OGTT in the previously diagnosed diabetic patients decreased as compared with the other three groups in pedigrees (P<0.05). Conclusions In type 2 diabetic pedigrees all members suffered from hyperinsulinemia, and in non diabetic first degree relatives, secretion function of islet β cells increased in order to maintain the normal glucose tolerance. In IGT patients compensating function of early stage secretion of islet had already decreased as compared with the first degree relatives. In diabetic patients, islet dysfunction became more significant, and the islet function had a tendency to decline further in patients with longer duration of diabetes.更多还原