【作者】 宋光耀； 赵亚芝； 刘蓉辉； 李萍； 卢亚敏； 刘敬珍； 叶蔚；

【Author】 Li Ping;Song Guang-yao;Liu Rong-hui;Lu Ya-min;Ye Wei;Liu Jing-zhen;Zhao Ya-zhi;Department of Endocrinology,Institute of Geriatric medicine,Hebei General Hospital;

【机构】 河北省人民医院；

【摘要】 目的:通过检测糖耐量正常的2型糖尿病一级亲属血脂、血糖、血清胰岛素,计算稳态模型胰岛素抵抗指数(HOMR-IR),了解糖耐量正常的2型糖尿病一级亲属人群腹内脂肪含量(VA)与胰岛素敏感性的关系。方法:将糖耐量正常的2型糖尿病一级亲属按HOMR-IR划分为胰岛素敏感组(IS组,110例,男44例,女66例)和胰岛素抵抗组(IR组,104例,男46例,女58例),行OGTT试验,分别测量体重指数(BMI)、腰围(WHC),采用葡萄糖氧化酶法测血糖,放免法测血清胰岛素。血清胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)均采用Beckman公司的试剂,在Beckman全自动生化分析仪上进行测试。SIEMENS SOMATOM Sensation 16CT机测定腹内脂肪面积(VA)和腹部皮下脂肪面积(SA),计算VA/SA值以及葡萄糖曲线下面积(AUCG)、胰岛素曲线下面积(AUCI)、C肽曲线下面积(AUCC),HOMR-IR来评估胰岛素敏感性,稳态模型β细胞功能(HOMA-β)、胰岛素分泌指数(△I/△G)来评估胰岛β细胞分泌功能。结果:(1)IR组空腹TG、VLDL较IS组有升高趋势,但无统计学意义(P>0.05);糖负荷后2h后,IR组TG、VLDL、apoB明显升高,均有统计学意义(P<0.05或P<0.01)。(2)IR组30min血糖、60min血糖明显升高,有统计学意义(P<0.01)。腰围、VA、VA/SA、TA在IR组显著高于IS组,有统计学意义(P<0.01)。IR组SA较IS组升高,有统计学意义(P<0.05)。IR组臀围较IS组有升高趋势,但无统计学意义(P>0.05),与IS组相比,IR组胰岛素高峰出现在60min,而IS组胰岛素高峰在30min。且IR组各时点胰岛素、C肽均高于IS组。IR组较IS组AUCG、AUCI、AUCC明显升高,有统计学意义。两组间HOMA-B、△I/△G没有统计学意义(P>0.05)。(3)WHC、BMI、VA/SA、TA与HOMA-IR的相关性(0.356、0.312、0.247)弱于VA、WC与HOMA-IR的相关性(0.415和0.405),多元回归分析显示VA是胰岛素敏感性的独立相关因素。结论:胰岛素抵抗的2型糖尿病一级亲属在NGT阶段已经出现脂代谢异常、中心性肥胖,糖负荷后30分钟、60分钟血糖的升高。更多还原

【Abstract】 Objective:To study the correlation between insulin sensitivity and visceral fat in NGT first degree relatives(FDRs) of T2 DM.Methods:To examine this issue,we studied the relationship of FDRs of T2 DM with insulin sensitivity and fat measures,measured by HOMA-IR and computed tomography,respectively.Visceral adiposity were evaluated with computed tomography at the L4-L5 intervertebral space.Results:The concentrations of TG、VLDL-C and apoB at 120 min after OGTT were markedly higher in IR group than IS group(P<0.05).The concentrations of glucose at 30,60 min after OGTT were markedly higher in IR group than IS group(P<0.05).WC、VA、VA/SA and TA were both comparable in the two groups.In multiple regression analysis VA significantly and independently contributed to the level of insulin sensitivity.There were no significant differences in HOMA-β、△I/△G.The correlation of VA、WC against HOMA-IR were stronger than WHC、BMI、VA/SA、TA.Conclusion:VA is most closely associated with insulin sensitivity.更多还原