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目的分析比较糖耐量受损(IGT)与2型糖尿病患者(T2DM)在胰岛β细胞功能以及胰岛素抵抗方面的差异,了解两组患者在口服葡萄糖耐量试验(OGTT)中血糖与胰岛素释放的关系以及胰岛素峰值出现的时间。方法 139例患者按照1999年WHO糖尿病的诊断标准以及75g葡萄糖OGTT结果,分为IGT组(n=29)和T2DM组(n=110),对两组患者在OGTT中血糖与胰岛素释放的关系进行相关分析,计算胰岛素峰值出现的时间,并采用稳态模型评估法比较两组患者胰岛素抵抗指数(HOMA-IR)和胰岛β细胞功能指数(HOMA-β)。结果两组受检者空腹血糖与负荷后的2h胰岛素以及胰岛素峰值均成负相关(rs=-0.644,P=0.000r,s=-0.529,P=0.003r,s=-0.518,P=0.004)。T2DM患者当空腹血糖值超过12mmol/L时,随着血糖值的升高,空腹胰岛素的水平也进一步降低,胰岛素峰值出现主要集中在1h~2h。T2DM患者的HOMA-IR值高于IGT患者(t=3.238,P=0.002),HOMA-β值低于IGT患者(t=-3.032,P=0.005)。结论从IGT到T2DM,HOMA-IR增加而HOMA-β降低,表明胰岛β细胞功能渐进性衰退和胰岛素敏感性的渐进性降低,在TGT阶段就开始加强监测和干预显得尤为重要。
Objective To compare the difference of pancreatic β-cell function and insulin resistance between patients with impaired glucose tolerance (IGT) and type 2 diabetes mellitus (T2DM), and to investigate the relationship between glucose and insulin release in oral glucose tolerance test (OGTT) Insulin peak appears time. Methods One hundred and ninety-nine patients were divided into IGT group (n = 29) and T2DM group (n = 110) according to the diagnostic criteria of WHO diabetes in 1999 and the results of 75g glucose OGTT. The relationship between blood glucose and insulin release in OGTT Correlation analysis was performed to calculate the peak time of insulin. HOMA-IR and HOMA-β were compared between the two groups using the steady-state model. Results The fasting blood glucose in both groups was negatively correlated with the 2h insulin and peak insulin levels after loading (rs = -0.644, P = 0.000r, s = -0.529, P = 0.003r, s = -0.518, P = 0.004 ). When the fasting blood glucose of T2DM patients exceeds 12mmol / L, the level of fasting insulin decreases further with the increase of blood glucose level, and the peak of insulin concentration mainly concentrates in 1h ~ 2h. The HOMA-IR of T2DM patients was higher than that of IGT patients (t = 3.238, P = 0.002), and the HOMA-β was lower than that of IGT patients (t = -3.032, P = 0.005). Conclusions From IGT to T2DM, HOMA-IR is increased and HOMA-β is decreased, indicating gradual declination of pancreatic β-cell function and insulin sensitivity. It is particularly important to strengthen monitoring and intervention during the TGT phase.