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目的探讨成人酮症起病肥胖糖尿病临床特征及其酮症起病的可能机制。方法选择新诊断糖尿病患者80例,根据入院时BMI、FBG和尿酮体状况分为非酮症组(A组)、非肥胖酮症组(B组)和肥胖酮症组(C组)。入院后均予胰岛素或胰岛素类似物强化治疗。应用稳态模型评估胰岛素抵抗指数(HOMA-IR)和胰岛β细胞功能(HOMA-β)。随访患者出院后病情转归和用药情况。结果 (1)3组胰岛素强化治疗前的FBG、2hBG比较差异均无统计学意义(P>0.05),C组HbA1c较A组降低(P<0.05)。C组BMI、TG水平、脂肪肝患病率和HOMA-IR均高于A、B组(P<0.05或P<0.01),而HDL-C降低(P<0.05),3组间TC、LDL-C比较差异无统计学意义(P>0.05)。(2)3组起病时均有IR和胰岛β细胞功能损害,C组IR更加严重。C组强化治疗后,多数患者可停用胰岛素或胰岛素类似物,甚至在一定时间内,单纯生活方式干预即可良好地控制血糖。结论酮症倾向肥胖糖尿病患者尚保存一定的胰岛β细胞功能。与普通T2DM患者相比,该型糖尿病患者有更严重的IR,解除脂毒性在病程中可能起到更重要的作用,其临床特征及自然病程更符合T2DM。
Objective To investigate the clinical features of adult ketosis-onset obesity and its possible mechanism of ketosis. Methods Eighty newly diagnosed diabetic patients were selected and divided into non-ketosis group (A group), non-obese ketosis group (B group) and obesity ketosis group (C group) according to the status of BMI, FBG and urine ketone on admission. Admission to insulin or insulin analogues were intensive treatment. The steady-state model was used to assess the insulin resistance index (HOMA-IR) and islet β-cell function (HOMA-β). Follow-up of patients after discharge from the hospital and medication situation. Results (1) There was no significant difference in FBG and 2hBG between the three groups before intensive insulin treatment (P> 0.05). HbA1c in group C was lower than that in group A (P <0.05). The levels of BMI and TG, the prevalence of fatty liver and the HOMA-IR of group C were significantly higher than those of group A and B (P <0.05 or P <0.01), while HDL-C was lower (P <0.05) -C no significant difference (P> 0.05). (2) Both IR and pancreatic islet β-cell dysfunction occurred in all three groups, and IR in group C was more serious. After intensive treatment in Group C, insulin or insulin analogs can be discontinued in most patients, and lifestyle interventions can control blood sugar even within a certain period of time. Conclusion Ketosis predisposed to obesity in patients with diabetes still preserved some β-cell function. Compared with T2DM patients, patients with this type of diabetes have more severe IR. Lipid detoxification may play a more important role in the course of the disease, and its clinical features and natural history are more consistent with T2DM.