上海交通大学学报（医学版）

›› 2011, Vol. 31 ›› Issue (11): 1603-.doi: 10.3969/j.issn.1674-8115.2011.11.021

• 论著（临床研究） • 上一篇    下一篇

糖调节受损患者的临床特征及2年自然转归分析

王申奇1,2, 陈惠芬3, 侯旭宏1, 沈 初3, 陆惠娟1, 潘志坚1, 贾伟平1   

  1. 1.上海交通大学附属第六人民医院内分泌代谢科 上海市糖尿病研究所 |上海市糖尿病重点实验室 上海市糖尿病临床医学中心, 上海 200233； 2.上海交通大学六院临床医学院, 上海 200233； 3.上海市嘉定区安亭镇社区卫生服务中心, 上海 201805
  • 出版日期:2011-11-28 发布日期:2011-11-29
  • 通讯作者: 贾伟平, 电子信箱: wpjia@sjtu.edu.cn。
  • 作者简介:王申奇（1987—）, 男, 硕士生；电子信箱: vito8622@hotmail.com。
  • 基金资助:

    上海市科委科研计划项目(08dj1400601, 09DZ1950202)；上海市嘉定区卫生局科研项目(KYXM2008-1112)

Clinical features and 2-year outcomes of patients with impaired glucose regulation

WANG Shen-qi1,2, CHEN Hui-fen3, HOU Xu-hong1, SHEN Chu3, LU Hui-juan1, PAN Zhi-jian1, JIA Wei-ping1   

  1. 1.Department of Endocrinology and Metabolism, the Sixth People's Hospital, Shanghai Jiaotong University, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Clinical Center for Diabetes, Shanghai 200233, China；2.Liuyuan School of Clinical Medicine, Shanghai Jiaotong University, Shanghai 200233, China；3.Shanghai Jiading District Anting Community Health Service Center, Shanghai 201805, China
  • Online:2011-11-28 Published:2011-11-29
  • Supported by:

    Shanghai Science and Technology Committee Foundation, 08dj1400601, 09DZ1950202；Shanghai Jiading District Health Bureau Foundation, KYXM2008-1112

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摘要：

目的 评价糖调节受损(IGR)不同亚型患者的胰岛素分泌功能和胰岛素敏感性，考察2年后糖耐量状态的自然转归情况。方法 对92例IGR患者完成为期2年的随访。基线和随访时均进行75 g口服葡萄糖耐量试验（OGTT）。以稳态模型(HOMA)法β细胞功能指数(HOMA-β)和β细胞分泌功能指数 (第一时相分泌功能指数 BCF-Ⅰ和第二时相分泌功能指数BCF-Ⅱ) 评价胰岛素分泌功能，以HOMA法胰岛素抵抗指数(HOMA-IR) 评价肝脏胰岛素敏感性，以胰岛素敏感指数(ISI)评价外周胰岛素敏感性。结果 根据基线OGTT 结果，92例IGR患者分为单纯空腹血糖受损组 (I-IFG组,n=16)、单纯糖耐量受损组 (I-IGT组，n=66)和混合糖调节受损组（CGI组，n=10)，三组患者年龄、性别构成、超重和(或)肥胖者比例以及血压和血脂指标比较差异均无统计学意义(P>0.05)；基线时HOMA-IR从高到低依次为CGI组、I-IFG 组和I-IGT组，ISI从低到高依次为CGI 组、I-IGT组和I-IFG组，BCF-Ⅰ从低到高依次为I-IFG 组、CGI组和I-IGT组，组间比较差异均有统计学意义（P<0.05)。在2年随访期内，20例IGR患者发展为糖尿病，累积发生率为21.7%。结论 IGT是IGR的主要表现形式。I-IFG人群的β细胞第一时相分泌功能受损最为明显；CGI人群的肝脏及外周胰岛素抵抗最为严重；I-IFG人群肝脏胰岛素抵抗较I-IGT人群严重，而外周胰岛素抵抗情况则相反。

关键词: 糖耐量, 糖尿病, 糖调节受损, 胰岛素抵抗, 转归

Abstract:

Objective To evaluate the insulin secretion and sensitivity in patients with different subtypes of impaired glucose regulation (IGR), and investigate the 2-year outcomes of glucose tolerance. Methods Ninety-two patients with IGR were followed up for 2 years. At baseline and during follow-up, 75 g oral glucose tolerance tests (OGTT) were performed. β cell function index of homeostasis model assessment (HOMA-β) and β cell secretion function (BCF) index (first-phase BCF, BCF-Ⅰ; second-phase BCF, BCF-Ⅱ) of homeostasis model assessment were employed to evaluate insulin secretion, insulin resistance index of homeostasis model assessment (HOMA-IR) was adopted to determine hepatic insulin sensitivity, and  insulin sensitivity index(ISI) was used to assess peripheral insulin sensitivity. Results According to baseline OGTT findings, 92 patients with IGR were divided into isolatedimpaired fasting glucose group (I-IFG group, n=16), isolated-impaired glucose tolerance group (I-IGT group, n=66) and complex glucose intolerance group (CGI group, n=10). There was no significant difference in age, gender, overweight/obesity, blood pressure and lipids among groups (P＞0.05). At baseline, HOMA-IR declined in the order of CGI group, I-IFG group and I-IGT group, ISI increased in the order of CGI group, I-IGT group and I-IFG group, and BCF-Ⅰincreased in the order of I-IFG group, CGI group and I-IGT group, with significant differences among groups (P<0.05 for all). During the follow-up for 2 years, 20 patients with IGF developed into diabetes mellitus, with the cumulative incidence of 21.7%. Conclusion IGT is the main form of IGR. Impairment of first-phase secretion of β cell is most significant in I-IFG population. CGI population has the most serious hepatic and peripheral insulin resistance. I-IFG population has more serious hepatic insulin resistance than I-IGT population, and that is opposite for peripheral insulin resistance.

Key words: glucose tolerance, diabetes, impaired glucose regulation, insulin resistance, outcome