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目的探讨原发性痛风患者不同糖代谢状态胰岛β细胞功能的演变及高胰岛素血症(HIns)在其中的作用。方法纳入原发性痛风患者139例,分为正常血糖-非高胰岛素血症(A)组、正常血糖-高胰岛素血症(B)组、IGR(C)组及糖尿病(D)组。统计及测量相关指标,计算IR相关指标。结果(1)A、C、D、B组胰岛素抵抗指数(HOMA-IR)依次升高,而ISI水平依次降低。除A组与C组外,其他组间HOMA-IR及ISI比较差异有统计学意义(P<0.05)。B组HOMA-IR及早时相胰岛素分泌指数(ΔI30/ΔG30)高于A组,而ISI低于A组(P<0.05);B组胰岛β细胞功能指数(HOMA-β)高于D组(P<0.05)。(2)回归分析显示,FIns、Ins 120min、HOMA-β、HOMA-IR、ΔI30/ΔG30与糖尿病独立相关,SUA水平与糖尿病无关。结论 IR、胰岛β细胞分泌障碍及胰岛素水平升高是原发性痛风患者发展为糖尿病的主要代谢特征。早期预防糖尿病应更加关注出现HIns但血糖正常的人群。
Objective To investigate the changes of pancreatic β-cell function in patients with primary gout and the role of hyperinsulinemia (HIns) in it. Methods One hundred and ninety-nine patients with primary gout were enrolled and divided into two groups: normal blood glucose-non-hyperinsulinemia group (A), normal blood glucose-hyperinsulinemia group (B), IGR group (C) and diabetes mellitus group. Statistics and measurement related indicators, calculate IR related indicators. Results (1) The insulin resistance index (HOMA-IR) of groups A, C, D and B increased in sequence, while the levels of ISI decreased in turn. Except group A and group C, HOMA-IR and ISI in the other groups were significantly different (P <0.05). HOMA-IR and early phase insulin secretion index (ΔI30 / ΔG30) in group B were higher than those in group A, but ISI was lower in group B than in group A (P <0.05) P <0.05). (2) Regression analysis showed that FIns, Ins 120min, HOMA-β, HOMA-IR and ΔI30 / ΔG30 were independently associated with diabetes. SUA level was not related to diabetes. Conclusion IR, pancreatic β-cell secretion disorders and elevated insulin levels are the main metabolic characteristics of patients with primary gout developing into diabetes. Early prevention of diabetes should pay more attention to the occurrence of HIns but normal blood glucose in the crowd.