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目的 研究单纯性肥胖、糖耐量减退 (IGT)和 2型糖尿病 (DM )患者胰岛素抵抗的发病机制。方法 用减少样本数的Bergman最小模型技术结合多样本静脉葡萄糖耐量试验分别测定正常人、单纯性肥胖、IGT和 2型DM患者胰岛素敏感性指数 (SI)、葡萄糖自身代谢效能 (SG)及胰岛 β细胞分泌功能 ,同时测定体重指数 (BMI)和腰臀比 (WHR)。结果 正常组的SI和SG 均明显高于IGT和 2型DM组 ,但与肥胖组相比 ,SG 差异无显著性 ,SI明显为高 ;正常组胰岛素分泌曲线下面积 1(AUC1)明显小于IGT组与单纯性肥胖组 (P <0 .0 5 ) ,但明显大于 2型DM组 (P <0 .0 2 ) ,而其胰岛素分泌曲线下面积 2 (AUC2 )明显小于其他 3组 ;在IGT与 2型DM中 ,前者的AUC1明显大于后者(P <0 .0 2 ) ,但两者的AUC2 差异无显著性 ;在所有研究对象中 ,SI与WHR、BMI均存在着明显的负相关 ,并且与WHR的关系更密切。结论 用减少样本数的Bergman最小模型技术可测知 (1)在单纯性肥胖组 ,SG 正常而SI降低 ;(2 )IGT与 2型DM组中不仅存在着明显的SG 降低 ,而且还存在着胰岛素抵抗和 β细胞分泌功能异常 ;(3) 2型DM组中 ,胰岛 β细胞第一时相的胰岛素分泌已有不足 ,且胰岛素抵抗与中央型肥胖有着密切的关系。
Objective To investigate the pathogenesis of insulin resistance in patients with simple obesity, impaired glucose tolerance (IGT) and type 2 diabetes mellitus (DM). Methods The Bergman minimal model with reduced number of samples combined with multi-sample intravenous glucose tolerance test were used to determine the insulin sensitivity index (SI), glucose self-metabolism (SG) and islet β in normal subjects, simple obesity, IGT and type 2 diabetes mellitus Cell secretion was measured simultaneously with body mass index (BMI) and waist-hip ratio (WHR). Results The SI and SG in normal group were significantly higher than those in IGT and DM group 2, but SG was not significantly different from that in obese group and SI was significantly higher than that in IGT group. The area under the insulin secretion curve 1 (AUC1) in normal group was significantly lower than that in IGT group Group and simple obesity group (P <0.05), but significantly higher than that of type 2 DM group (P <0. 02), while the area under the insulin secretion curve 2 (AUC2) was significantly less than the other three groups; And type 2 DM, the former AUC1 was significantly greater than the latter (P <0. 02), but the difference between the two AUC2 no significant; in all subjects, SI and WHR, BMI there is a significant negative correlation , And has a closer relationship with WHR. Conclusions Bergman’s minimal model technique with reduced number of samples can be used to detect (1) normal SG and decreased SI in simple obesity group; (2) there is not only obvious SG decrease in IGT and DM group 2 Insulin resistance and abnormal secretion of β cells. (3) Insulin secretion in the first phase of pancreatic β-cells in type 2 diabetes mellitus was insufficient, and insulin resistance was closely related to central obesity.