CAJ | 학술논문

目的探讨2型糖尿病(T2DM)患者正常糖耐量(NGT)一级亲属(简称一级亲属)胰岛素抵抗(IR)及其与人体测量指数、血脂、肿瘤坏死因子-α(TNF-α)、游离脂肪酸(FFA)、瘦素(Lep)等参数的关系. 方法以NGT一级亲属(58名)为观察组,34名性别、年龄、体质指数(BMI)与之相匹配的无糖尿病家族史的正常人为对照组,比较两组口服75 g葡萄糖耐量试验(OGTT)中0、60、90、120 min血糖(BG)、胰岛素(Ins)、C肽(CP),空腹血脂、TNF-α、FFA、Lep以及用稳态模型法(HOMA)计算的胰岛素抵抗指数(HOMA-IR),并进行相关性分析. 结果 (1)一级亲属组比正常对照组血浆总胆固醇(TC)、甘油三酯(TG)显著升高(P<0.05,P<0.01).OGTT中60、90、120 min BG及0 min Ins、CP显著高于正常对照组(P<0.01).一级亲属组葡萄糖曲线下面积[Glu(AUC)]高于正常对照组(P<0.01),而两组胰岛素曲线下面积[Ins(AUC)]比较差异无显著意义.一级亲属组HOMAIR为3.70±1.94,较正常对照组(2.73±0.59)显著升高(P<0.01).一级亲属组中血TNF-α高于对照组(P<0.01).(2)一级亲属组BMI＜23、23≤BMI＜25、BMI≥25三个亚组之间TG,0、60、90、120 min BG,Ins,CP及HOMA-IR,血浆Lep随BMI的增加而增加,组间比较差异有非常显著意义(P<0.01).(3)HOMA-IR与 BMI、WHR、TG、Glu0、Ins0、CP0、Glu(AUC)、Ins(AUC)有显著的相关性(P<0.01),FFA与Glu(AUC)有显著相关(r＝0.31,P＝0.019). 结论 T2DM患者NGT一级亲属在BG正常时已存在脂代谢异常、高Ins血症和IR,而且,随着体重的增加,IR和脂代谢紊乱更趋严重.血循环中TNF-α的升高与IR有关.FFA的升高与糖调节异常有关.
목적탐토2형당뇨병(T2DM)환자정상당내량(NGT)일급친속(간칭일급친속)이도소저항(IR)급기여인체측량지수、혈지、종류배사인자-α(TNF-α)、유리지방산(FFA)、수소(Lep)등삼수적관계. 방법이NGT일급친속(58명)위관찰조,34명성별、년령、체질지수(BMI)여지상필배적무당뇨병가족사적정상인위대조조,비교량조구복75 g포도당내량시험(OGTT)중0、60、90、120 min혈당(BG)、이도소(Ins)、C태(CP),공복혈지、TNF-α、FFA、Lep이급용은태모형법(HOMA)계산적이도소저항지수(HOMA-IR),병진행상관성분석. 결과 (1)일급친속조비정상대조조혈장총담고순(TC)、감유삼지(TG)현저승고(P<0.05,P<0.01).OGTT중60、90、120 min BG급0 min Ins、CP현저고우정상대조조(P<0.01).일급친속조포도당곡선하면적[Glu(AUC)]고우정상대조조(P<0.01),이량조이도소곡선하면적[Ins(AUC)]비교차이무현저의의.일급친속조HOMAIR위3.70±1.94,교정상대조조(2.73±0.59)현저승고(P<0.01).일급친속조중혈TNF-α고우대조조(P<0.01).(2)일급친속조BMI＜23、23≤BMI＜25、BMI≥25삼개아조지간TG,0、60、90、120 min BG,Ins,CP급HOMA-IR,혈장Lep수BMI적증가이증가,조간비교차이유비상현저의의(P<0.01).(3)HOMA-IR여 BMI、WHR、TG、Glu0、Ins0、CP0、Glu(AUC)、Ins(AUC)유현저적상관성(P<0.01),FFA여Glu(AUC)유현저상관(r＝0.31,P＝0.019). 결론 T2DM환자NGT일급친속재BG정상시이존재지대사이상、고Ins혈증화IR,이차,수착체중적증가,IR화지대사문란경추엄중.혈순배중TNF-α적승고여IR유관.FFA적승고여당조절이상유관.
ObjectiveTo study insulin resistance in the NG T first-degree relatives of type 2 diabetics and the relationship of anthropometr ic, blood lipids, TNF-α, FFA and leptin with insulin resistance.Meth odsA total of 58 NGT first-degree relatives of type 2 diabetics and 3 4 sex-, age- and BMI-matched control subjects without a family history of dia betics were joined, All subjects underwent a 75 g OGTT for determinations of 0, 60, 90, 120 minutes glucose, insulin and C-peptide, and baseline blood lipids, TNF-α, FFA, leptin. Insulin resistance was estimated using the homeostasis as sessment (HOMA).The relationship between HOMA-IR and the other variables was as sessed.Results(1) TC and TG were higher in relatives than in controls (P<0.05,P<0.01). Ins and CP at 0 minute and glucose at 60, 90, 12 0 minutes after OGTT were significantly higher in relatives (P<0 01). The m ean glucose(AUC) in relatives was higher than that in controls(P<0.01),an d the mean Ins(AUC) had no difference between the relatives and the controls . T he HOMA-IR in relatives (3.70±1.94)was higher than that in controls (2.73 ±0.59)(P<0.01). The mean TNF-α concentration in relatives was higher tha n that in controls (P<0.01). (2) The first-degree relatives were classified three subgroups according to BMI<23, 23≤BMI<25, BMI≥25. With BMI increasing , TG, 0, 60, 90, 120 minutes glucose, Ins, CP, HOMA-IR , leptin were signifi cantly increased (P<0.001).(3) HOMA-IR is significantly correlated with BMI , WHR, TG, Glu0, Ins 0, CP 0, Glu(AUC), Ins(AUC) (P<0.001). A significant co rrelation can be found between FFA and Glu(AUC)(r=0.31, P=0.019). ConclusionsHyperinsulinemia and insulin resistance could appear early in normoglycemic first-degree relatives of type 2 diabetics. With BMI increasin g, the severities of insulin resistance and dyslipidemia are increased in the fi rst-degree relatives. Circulating TNF-α is correlated with insulin resistance . FFA is correlated with deteriorated glucose tolerance.