CAJ | 학술논문

目的探讨不同胰岛β细胞功能指数评价不同病程2型糖尿病(T2DM)患者糖代谢的作用.方法选取无糖尿病家族史的糖耐量正常者48例(对照组)和T2DM患者182例,T2DM患者根据病程不同分为＜5年组(DM＜5组)74例、5～10年组(DM5 ～10组)51例和＞10年组(DM＞10组)57例.行口服葡萄糖耐量试验(OGTT)和胰岛素释放试验,以稳态模型评估的胰岛素抵抗指数(HOMA-IR)和全身胰岛素敏感指数[ISI(Matsuda)]评估胰岛素敏感性；以早期胰岛素分泌功能指数(△I30/△G30)和葡萄糖处置指数(DI)评估胰岛β细胞功能.结果 DM＜5组、DM5～10组和DM＞10组HOMA-IR较对照组升高(8.78±7.12、8.08±3.67、7.84±5.08比4.76±3.43,P＜ 0.05),ISI(Matsuda)较对照组降低(46.78±29.00、36.71±16.67、38.86±21.72比61.13±32.08,P＜0.05),DM＜5组、DM5～10组和DM＞10组比较差异无统计学意义(P＞0.05).DM＜5组、DM5～10组和DM＞10组△I30/△G30和DI均较对照组降低[△I30/△G30:(68.41±361.52)、(4.31±3.42)、(7.70±5.78) mU/mmol比(92.65±309.29)mU/mmol; DI:0.0421±0.0123、0.0412±0.0123、0.0363±0.0116比0.1151±0.0236,P＜ 0.05]. DM＜5组、DM5-10组和DM＞10组△I30/△G30比较差异无统计学意义(P＞0.05)；与DM＜5组和DM5～10组比较,DM＞10组DI显著降低(P＜0.05).结论 HOMA-IR、ISI(Matsuda)、△I30/△G30对评价不同病程胰岛素抵抗程度敏感性不高；DI能更早地反映胰岛β细胞对葡萄糖的利用,调节血糖稳态能力的变化.
목적 탐토불동이도β세포공능지수평개불동병정2형당뇨병(T2DM)환자당대사적작용.방법 선취무당뇨병가족사적당내량정상자48례(대조조)화T2DM환자182례,T2DM환자근거병정불동분위＜5년조(DM＜5조)74례、5～10년조(DM5 ～10조)51례화＞10년조(DM＞10조)57례.행구복포도당내량시험(OGTT)화이도소석방시험,이은태모형평고적이도소저항지수(HOMA-IR)화전신이도소민감지수[ISI(Matsuda)]평고이도소민감성；이조기이도소분비공능지수(△I30/△G30)화포도당처치지수(DI)평고이도β세포공능.결과 DM＜5조、DM5～10조화DM＞10조HOMA-IR교대조조승고(8.78±7.12、8.08±3.67、7.84±5.08비4.76±3.43,P＜ 0.05),ISI(Matsuda)교대조조강저(46.78±29.00、36.71±16.67、38.86±21.72비61.13±32.08,P＜0.05),DM＜5조、DM5～10조화DM＞10조비교차이무통계학의의(P＞0.05).DM＜5조、DM5～10조화DM＞10조△I30/△G30화DI균교대조조강저[△I30/△G30:(68.41±361.52)、(4.31±3.42)、(7.70±5.78) mU/mmol비(92.65±309.29)mU/mmol; DI:0.0421±0.0123、0.0412±0.0123、0.0363±0.0116비0.1151±0.0236,P＜ 0.05]. DM＜5조、DM5-10조화DM＞10조△I30/△G30비교차이무통계학의의(P＞0.05)；여DM＜5조화DM5～10조비교,DM＞10조DI현저강저(P＜0.05).결론 HOMA-IR、ISI(Matsuda)、△I30/△G30대평개불동병정이도소저항정도민감성불고；DI능경조지반영이도β세포대포도당적이용,조절혈당은태능력적변화.
Objective To assess the role of the different pancreatic islet β cell function index in the evaluation of glucose metabolism in different duration of type 2 diabetes mellitus (T2DM).Methods Normal glucose tolerance subjects without diabetes family history (NC group,48 cases) and T2DM patients (182 cases) were enrolled.The T2DM patients were divided into three groups:less than 5 years group (DM ＜5 group,74 cases),5-10 years group (DM5-10 group,51 cases) and more than 10 years group ( DM ＞10 group,57 cases).Oral glucose tolerance test (OGTT) and insulin release test were taken in all groups.Insulin resistance index (HOMA-IR) and whole body insulin sensitivity index [ISI(Matsuda)] were used to estimate insulin sensitivity,and early insulin secretion index ( △ I30/ △ G30) and glucose disposition index (DI) were used to evaluate the function of pancreatic islet β cell.Results HOMA-IR was increased and ISI (Matsuda) was decreased in DM ＜5 group,DM5-10 group and DM ＞10 group compared with those in NC group [HOMA-IR:8.78 ± 7.12,8.08 ± 3.67,7.84 ± 5.08 vs.4.76 ± 3.43;ISI(Matsuda):46.78 ± 29.00,36.71 ± 16.67,38.86 ±21.72 vs.61.13 ± 32.08,P ＜ 0.05],however,there was no significant difference among DM ＜5 group,DM5-10 group and DM ＞10 group.△ I30/ △ G30 and DI were decreased in DM ＜5 group,DM5-10 group and DM ＞10 group compared with those in NC group [ △ I30 △ G30:( 68.41 ± 361.52 ),(4.31 ± 3.42 ),(7.70 ± 5.78 ) mU/mmol vs.(92.65 ± 309.29) mU/mmol;DI:0.0421 ± 0.0123,0.0412 ± 0.0123,0.0363 ± 0.0116 vs.0.1151 ± 0.0236,P ＜ 0.05 ],and there was no significant difference in △ I30 / △ G30 among DM ＜5 group,DM5-10 group and DM ＞10 group,however,DI was decreased in DM＞10 group compared with that in DM＜5 group and DM5-10 group (P＜0.05).Conclusions HOMA-IR,ISI (Matsuda),△I30/△G30 are not sensitive to evaluate the insulin resistance of different duration.DI can reflect the glucose utilization of pancreatic islet β cell earlier and the ability to regulate blood sugar steady state changes.