非糖尿病患者胰岛β细胞功能减退的因素分析
비당뇨병환자이도β세포공능감퇴적인소분석
A correlative study of β cell hypofunction and the related factors in non-diabetic patients
  • 万方数据
    中国医师进修杂志 중국의사진수잡지
    CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
    2013年 22期 5-9 ,共5页

    李利阳%梁文浩%王丽琼%胡源%杨蕾%董宝宁%虎晓燕%魏欣辉%李鹏

    리리양%량문호%왕려경%호원%양뢰%동보저%호효연%위흔휘%리붕

    腰臀比%甘油三酯类%血压%胰岛素分泌细胞 腰臀比%甘油三酯類%血壓%胰島素分泌細胞
    요둔비%감유삼지류%혈압%이도소분비세포
    Waist-hip ratio%Triglycerides%Blood pressure%Insulin-secreting cells
    目的 探讨非糖尿病患者胰岛β细胞功能减退的特点及其相关因素的影响.方法 选择非糖尿病患者378例[存在下列指标中的任何一项异常:肥胖、血压、血脂、尿酸、C反应蛋白(CRP)、纤维蛋白原(FIB)、甲状腺功能、同型半胱氨酸(Hcy)、脂肪肝、焦虑状态]和健康体检者50例(健康对照),检测或计算血压、体质指数(BMI)、腰臀比、三酰甘油(TG)、低密度脂蛋白胆固醇(LDLC)、尿酸、CRP、FIB、甲状腺功能、Hcy;标准馒头餐试验检测胰岛素、血糖,计算稳态模型评估法胰岛β细胞功能指数(HOMA-β)、经胰岛素抵抗指数校正的糖负荷后30 min胰岛素净增值/葡萄糖净增值[(△I30/△ G30)/IR]、经胰岛素抵抗指数校正的糖负荷后120 min胰岛素净增值/葡萄糖净增值[(△I120/△G120)/IR]和修正胰岛β细胞功能指数(MBCI);行腹部B超检查观察有无脂肪肝;行修订状态-特质焦虑问卷调查有无焦虑状态.结果 高收缩压、高TG、甲状腺功能亢进(甲亢)、高腰臀比患者(△I30/△G30)/IR低于健康对照者(14.24±10.25、13.58±9.14、13.45±9.89、13.71±9.67比20.72±17.03),高TG患者HOMA-β高于健康对照者(5.87±1.37比4.91±1.75),差异均有统计学意义(P＜0.05).早相胰岛β细胞功能受损[(△I30/△G30)/IR＜ 15.78,166例]患者收缩压、TG、腰臀比、甲亢程度[促甲状腺素(TSH)]与早相胰岛β细胞功能正常[(△I30/△G30)/IR≥15.78,262例]患者比较差异有统计学意义[(163.50±10.92) mm Hg(1 mm Hg=0.133 kPa)比(136.40±11.47) mm Hg、(2.23±0.69)mmol/L比(1.42±0.53) mmol/L、1.00±0.08比0.81±0.06、(0.29±0.22) mU/L比(3.26±1.37) mU/L,P＜0.05].多因素Logistic回归分析结果显示腰臀比、TG、收缩压、甲亢程度(TSH)为早相胰岛β细胞功能的独立影响因素(P＜ 0.05或＜0.01).糖耐量异常患者(45例)MBCI、(△I30/△G30)/IR明显低于健康对照者(5.87±2.91比7.42±3.39、12.09±10.56比20.72±17.03),差异有统计学意义(P＜0.05);空腹血糖受损患者(47例)HOMA-β低于健康对照者(4.25±1.22比4.91±1.75),差异有统计学意义(P＜0.05);三者(△I120/△G120)/IR比较差异无统计学意义(P＞0.05).结论 腰臀比、TG、收缩压、甲亢程度等为独立影响早相胰岛β细胞功能的因素.对其相关因素进行干预治疗,早相胰岛β细胞功能会有所改善.
    목적 탐토비당뇨병환자이도β세포공능감퇴적특점급기상관인소적영향.방법 선택비당뇨병환자378례[존재하렬지표중적임하일항이상:비반、혈압、혈지、뇨산、C반응단백(CRP)、섬유단백원(FIB)、갑상선공능、동형반광안산(Hcy)、지방간、초필상태]화건강체검자50례(건강대조),검측혹계산혈압、체질지수(BMI)、요둔비、삼선감유(TG)、저밀도지단백담고순(LDLC)、뇨산、CRP、FIB、갑상선공능、Hcy;표준만두찬시험검측이도소、혈당,계산은태모형평고법이도β세포공능지수(HOMA-β)、경이도소저항지수교정적당부하후30 min이도소정증치/포도당정증치[(△I30/△ G30)/IR]、경이도소저항지수교정적당부하후120 min이도소정증치/포도당정증치[(△I120/△G120)/IR]화수정이도β세포공능지수(MBCI);행복부B초검사관찰유무지방간;행수정상태-특질초필문권조사유무초필상태.결과 고수축압、고TG、갑상선공능항진(갑항)、고요둔비환자(△I30/△G30)/IR저우건강대조자(14.24±10.25、13.58±9.14、13.45±9.89、13.71±9.67비20.72±17.03),고TG환자HOMA-β고우건강대조자(5.87±1.37비4.91±1.75),차이균유통계학의의(P＜0.05).조상이도β세포공능수손[(△I30/△G30)/IR＜ 15.78,166례]환자수축압、TG、요둔비、갑항정도[촉갑상선소(TSH)]여조상이도β세포공능정상[(△I30/△G30)/IR≥15.78,262례]환자비교차이유통계학의의[(163.50±10.92) mm Hg(1 mm Hg=0.133 kPa)비(136.40±11.47) mm Hg、(2.23±0.69)mmol/L비(1.42±0.53) mmol/L、1.00±0.08비0.81±0.06、(0.29±0.22) mU/L비(3.26±1.37) mU/L,P＜0.05].다인소Logistic회귀분석결과현시요둔비、TG、수축압、갑항정도(TSH)위조상이도β세포공능적독립영향인소(P＜ 0.05혹＜0.01).당내량이상환자(45례)MBCI、(△I30/△G30)/IR명현저우건강대조자(5.87±2.91비7.42±3.39、12.09±10.56비20.72±17.03),차이유통계학의의(P＜0.05);공복혈당수손환자(47례)HOMA-β저우건강대조자(4.25±1.22비4.91±1.75),차이유통계학의의(P＜0.05);삼자(△I120/△G120)/IR비교차이무통계학의의(P＞0.05).결론 요둔비、TG、수축압、갑항정도등위독립영향조상이도β세포공능적인소.대기상관인소진행간예치료,조상이도β세포공능회유소개선.
    Objective To study the characteristics and influencing factors of β cell hypofunction in non-diabetic patients.Methods Three hundred and seventy-eight cases of non-diabetic patients (who had one abnormal index in the following:obesity,blood pressure,blood lipid,uric acid,C reactive protein (CRP),fibrinogen (FIB),thyroid function,homocysteine (Hcy),fatty liver,anxiety) and 50 cases of healthy people were selected.Blood pressure,body mass index (BMI),waist-hip ratio,triglycerides (TG),low density lipoprotein cholesterol (LDL-C),uric acid,CRP,FIB,thyroid function and Hcy was recorded.Through steamed bread meal test,blood glucose and insulin was recorded.The figures inclued homeostasis model assessment model β-cell function index(HOMA-β),early-phase insulin secretion[(△I30/△G30)/IR],second-phase secretion [(△I120/△G120)/IR] and corrected human β cell function index (MBCI) were calculated.The fatty liver could be found by B ultrasound.All subjects completed tests of the State-Trait Anxiety Inventory-From Y questionnaire.Results The (△I30/△G30)/IR of patients with elevated systolic blood pressure (SBP),elevated TG,hyperthyroidism (TSH) and high waist-hip ratio was lower than that in healthy people (14.24 ± 10.25,13.58 ± 9.14,13.45 ± 9.89,13.71 ± 9.67 vs.20.72 ± 17.03,P ＜ 0.05).The HOMA-β of patients with elevated TG was lower than that in healthy people (5.87 ± 1.37 vs.4.91 ± 1.75).The levels of SBP,TG,waist-hip ratio and TSH in patients with β cell hypofunction [(△I30/△G30)/IR ＜15.78,166 cases] showed significant difference compared with that in patients with β cell normal function [(△I30/△G30)/IR ≥ 15.78,262 cases][(163.50 ± 10.92) mm Hg (1 mm Hg =0.133 kPa) vs.(136.40 ±11.47) mm Hg,(2.23 ± 0.69) mmol/L vs.(1.42 ± 0.53) mmol/L,1.00 ± 0.08 vs.0.81 ± 0.06,(0.29 ± 0.22)mU/L vs.(3.26 ± 1.37) mU/L,P ＜ 0.05].Logistic regression analysis showed that the levels of waist-hip ratio,TG,SBP and TSH were independent factors to affect early insulin secretion function factors (P ＜ 0.05 or ＜ 0.01).The MBCI and(△I30/△G30)/IR in impaired glucose tolerance patients (45 cases) was significantly lower than that in healthy people (5.87 ± 2.91 vs.7.42 ± 3.39,12.09 ± 10.56 vs.20.72 ± 17.03,P ＜ 0.05).The HOMA-β in impaired fasting glucose patients (47 cases) was lower than that in healthy people (4.25 ±1.22 vs.4.91 ± 1.75,P ＜ 0.05).There was no significant difference in(△ I120/△G120)/IR among them (P ＞ 0.05).Conclusions The levels of waist-hip ratio,TG,SBP and hyperthyroidism may be the independent factors to affect early insulin secretion function.After the intervention of influencing factors,early insulin secretion function is improved.
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