CAJ | 학술논문

目的分析口服葡萄糖耐量试验(OGTT)负荷后0.5h高血糖者的血糖波动特征.方法 4 351名受试者行OGTT试验,根据笔者前期试验得出诊断糖代谢异常的0.5h血糖(0.5 hPG)切点值将整个人群分为糖耐量正常组(n=1 370)、糖尿病前期组(n=1 131)及糖尿病组(n=1 850),进行0.5 hPG诊断标准及2008年美国糖尿病协会(ADA)诊断标准的一致性检验,比较3组的糖负荷后血糖及胰岛素峰值、胰岛素增量、糖负荷后血糖波动、胰岛素生成指数、Mastuda胰岛素敏感指数、30 min处置指数(DI30),并进行糖负荷后血糖波动与上述指标的线性相关性分析.结果 0.5 hPG诊断标准与2008年ADA诊断标准具有较好的一致性(Kappa=0.563,P＜0.001).应用0.5 hPG诊断的糖耐量正常组、糖尿病前期组的糖负荷后血糖峰值多数出现在1h,而糖尿病组的血糖峰值则较多出现在2 h(x2 =710.74,P＜0.001).随着0.5 hPG水平的升高,3组糖负荷后血糖峰值及血糖波动依次增加(F =3 313.21,2 580.53,P均＜0.01),而空腹胰岛素、糖负荷后胰岛素峰值、胰岛素增量、生成指数、Matsuda胰岛素敏感指数及DI30逐渐下降(F=8.78～1 697.16,P均＜0.01).糖负荷后血糖波动与生成指数、Matsuda胰岛素敏感指数、DI30呈负相关(r=-0.114,-0.148,-0.639,P均＜0.01),与0.5 hPG呈正相关(r=0.796,P＜0.01).结论 0.5 hPG是诊断糖代谢异常的良好补充,0.5h高血糖人群中随着血糖水平的升高其糖负荷后血糖峰值出现时间逐渐后延,并且糖负荷后血糖波动逐渐加大.糖负荷后的血糖波动与早时相分泌功能及胰岛素敏感性有关.
목적 분석구복포도당내량시험(OGTT)부하후0.5h고혈당자적혈당파동특정.방법 4 351명수시자행OGTT시험,근거필자전기시험득출진단당대사이상적0.5h혈당(0.5 hPG)절점치장정개인군분위당내량정상조(n=1 370)、당뇨병전기조(n=1 131)급당뇨병조(n=1 850),진행0.5 hPG진단표준급2008년미국당뇨병협회(ADA)진단표준적일치성검험,비교3조적당부하후혈당급이도소봉치、이도소증량、당부하후혈당파동、이도소생성지수、Mastuda이도소민감지수、30 min처치지수(DI30),병진행당부하후혈당파동여상술지표적선성상관성분석.결과 0.5 hPG진단표준여2008년ADA진단표준구유교호적일치성(Kappa=0.563,P＜0.001).응용0.5 hPG진단적당내량정상조、당뇨병전기조적당부하후혈당봉치다수출현재1h,이당뇨병조적혈당봉치칙교다출현재2 h(x2 =710.74,P＜0.001).수착0.5 hPG수평적승고,3조당부하후혈당봉치급혈당파동의차증가(F =3 313.21,2 580.53,P균＜0.01),이공복이도소、당부하후이도소봉치、이도소증량、생성지수、Matsuda이도소민감지수급DI30축점하강(F=8.78～1 697.16,P균＜0.01).당부하후혈당파동여생성지수、Matsuda이도소민감지수、DI30정부상관(r=-0.114,-0.148,-0.639,P균＜0.01),여0.5 hPG정정상관(r=0.796,P＜0.01).결론 0.5 hPG시진단당대사이상적량호보충,0.5h고혈당인군중수착혈당수평적승고기당부하후혈당봉치출현시간축점후연,병차당부하후혈당파동축점가대.당부하후적혈당파동여조시상분비공능급이도소민감성유관.
Objective To determine the characteristics of glycemic excursion of hyperglycemia at 0.5 h during oral glucose tolerance test(OGTT).Methods A total of 4 351 subjects were recruited to take an OGTT.According to the cutoff values of 0.5 h plasma glucose (0.5 hPG) for diagnosing glucose metabolic abnormalities which were concluded in the preliminary experiments by author,all subjects were divided into three groups:normal glucose tolerance group (n =1 370),prediabetes mellitus group (n =1 131) and diabetes mellitus group (n =1 850),and the consistency between 2008 American Diabetes Association (ADA) diagnostic criteria and 0.5 hPG cutoff value was performed.Then the peak plasma glucose and insulin,insulin increment,glucose excursion,insulingenic index,Mastuda insulin insensitivity index,30 min disposal index among three groups were compared.The correlation between plasma glucose excursion and β-cell function,insulin sensitivity was analyzed with linear correlation.Results 2008-ADA diagnostic criteria and 0.5 hPG diagnostic criteria had good consistency (Kappa =0.563,P ＜ 0.001).According to 0.5 hPG cutoff value,peak of plasma glucose occurred at 1-hour in normal glucose tolerance group and prediabetes mellitus group,and 2-hour in diabetes mellitus group(x2 =710.74,P ＜ 0.001).Following with the increase of 0.5 hPG,peak plasma glucose and glucose excursion were also increased (F =3 313.21,2 580.53,all P ＜ 0.01).However,fasting insulin,insulin peak after glucose loading,insulin increment,insulingenic index,Mastuda insulin insensitivity index and 30 min disposal index decreased (F =8.78-1 697.16,all P ＜0.01).There was a negative correlation between glucose excursion and insulingenic index,Mastuda insulin insensitivity index,30 min disposal index (r =-0.114,-0.148,-0.639,all P ＜ 0.01),and a positive correlation between 0.5 hPG (r =0.796,P ＜ 0.01).Conclusions 0.5 hPG cutoff value is a good supplement for diagnosis of glucose metabolism.The peak of plasma glucose delays and the plasma glucose excursion increases followed with the increase of plasma glucose in subjects with hyperglycemia at 0.5 h post glucose-load.Plasma glucose excursion is influenced by early-phase insulin secretion and insulin sensitivity.