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目的探讨不同糖耐量人群胰岛素抵抗和胰岛B细胞的分泌功能。方法根据口服葡萄糖耐量(OGTT)结果,将147例入选者分为糖耐量正常(NGT)组,糖耐量减退(IGT)组和糖尿病(DM)组,测定空腹和服糖后2h真胰岛素(FTI、TI2h)、空腹游离脂肪酸(FFA)、瘦素(Lep)、胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C),计算胰岛素抵抗指数(HOMA-IR)和胰岛素分泌指数(HOMA-β),并对有些数据作相关分析。结果IGT组和DM组的血糖、TI、FFA、Lep、TG、LDL-C含量及HOMA-IR高于NGT组(均P<0.01),HDL-C含量及HOMA-β均低于NGT组(均P<0.01);DM组HO-MA-IR和HOMA-β分别高于和低于IGT组(均P<0.01)。TG与FFA之间以及Lep与FFA之间呈正相关(r分别为0.7061、0.3436,均P<0.01);FFA与HOMA-IR正相关(r=0.5452,P<0.001),与HOMA-β负相关(r=-0.3634,P<0.01);FFA、Lep与HOMA-IR独立相关(标准回归系数分别为0.2902、0.3217,均P<0.05),FFA与HOMA-β独立相关(标准回归系数为-0.4906,P<0.001)。结论糖代谢异常早期阶段存在明显胰岛素抵抗,胰岛B细胞分泌功能障碍随着病程的进展逐渐加重,脂毒性在这一过程中起重要作用。
Objective To investigate insulin resistance and pancreatic B cell secretion in different glucose tolerance population. Methods According to oral glucose tolerance (OGTT) results, 147 patients were divided into three groups: normal glucose tolerance group, impaired glucose tolerance group and diabetic group. The levels of true insulin (FTI, TI2h, FFA, Lep, TC, TG, HDL-C and LDL-C, Calculate insulin resistance index (HOMA-IR) and insulin secretion index (HOMA-β), and some of the data for correlation analysis. Results The levels of plasma glucose, TI, FFA, Lep, TG, LDL-C and HOMA-IR in IGT group and DM group were significantly higher than those in NGT group (all P <0.01) P <0.01). HO-MA-IR and HOMA-β in DM group were higher than those in IGT group (all P <0.01). There was a positive correlation between TG and FFA and between Lep and FFA (r = 0.7061,0.3436, all P <0.01). There was a negative correlation between FFA and HOMA-IR (r = 0.5452, (r = -0.3634, P <0.01). FFA and Lep were independently associated with HOMA-IR (the standard regression coefficients were 0.2902 and 0.3217 respectively, all P <0.05). FFA was independently associated with HOMA-β (the standard regression coefficient was -0.4906 , P <0.001). Conclusion There is obvious insulin resistance in the early stages of abnormal glucose metabolism. The secretion dysfunction of pancreatic islet B cells gradually aggravates with the course of the disease. Lipotoxicity plays an important role in this process.