非糖尿病高胰岛素血症人群的胰岛b细胞功能分析

Function of islet β cells in non-diabetic population with hyperinsulinemia

摘要:

目的 分析正常血糖及糖调节受损合并高胰岛素血症（HINS）人群的胰岛β细胞功能状态。方法 对北京某高校年度查体人员中无糖尿病史者行口服75 g葡萄糖耐量试验（75g OGTT）, 资料完整的非糖尿病人群共634例, 其中HINS者94例, 分析正常血糖及糖调节受损HINS人群的胰岛功能的差异。结果 正常血糖及糖调节受损人群中高胰岛素组胰岛素抵抗指数HOMA-IR、?I120/?G120、第一时相及第二时相胰岛素分泌指数显著高于对照组（P＜0.05）; 胰岛素敏感指数（ISI-Stumvoll）、HOMA-IR校正后β细胞功能指数（HBCI/IR）显著低于对照组（P＜0.05）; β细胞功能指数（HBCI）高于对照组, 但差异无统计学意义（P＞0.05）; ?I120/?G120/IR两组间无统计学差异（P＞0.05）。糖调节受损HINS组年龄、服糖后2 h血糖、总胆固醇、低密度脂蛋白胆固醇、收缩压、2h胰岛素水平显著高于正常血糖HINS组（P＜0.05）; HBCI、HBCI/IR、第一时相及第二时相胰岛素分泌指数显著低于正常血糖HINS组（P＜0.05）; HOMA-IR和ISI-Stumvoll两组间无统计学差异（P＞0.05）。结论 正常血糖及糖调节受损HINS人群虽然胰岛素分泌绝对值增加, 但实际的胰岛β细胞功能在逐渐减退。正常血糖-HINS和糖调节受损-HINS是2型糖尿病发生发展的中间过渡状态, 应该尽早检出、早期干预。

Abstract:

Objective To analyze the function of islet β cells in population who had normal glucose tolerance (NGT) or impaired glucose regulation (IGR) with hyperinsulinemia(HINS). Methods A total of 634 adults diagnosed as NGT or IGR with HINS by 75g oral glucose tolerance test(OGTT) were included for the analysis of the islet β cells function. Results In HINS group, homeostasis model insulin resistance index(HOMA-IR), ?I120/?G120, the first and second phase insulin secretion index were significantly higher than those in non-HINS group of non-diabetic population(P＜0.05), but insulin sensitive index(ISI)-Stumvoll and HOMA beta cells function index/insulin resistance(HBCI/IR) were significantly lower(P＜0.05). There was no significant difference in ?I120/?G120/IR between the two groups(P＞0.05). In IGR with HINS group, HBCI, HBCI/IR, and the first and second phase insulin secretion index were significantly lower than those in NGT with HINS group(P＜0.05). There was no significant difference in HOMA-IR and ISI-Stumvoll between the two groups(P＞0.05). Conclusions Although the absolute insulin secretion is increasing in the NGT or IGR population with HINS, the islet ? cells function decreases gradually. NGT or IGR with HINS are the transition state in the progress of diabetes mellitus, and the early detection and interference are strongly recommended.