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目的评估上海居民糖代谢状况,观察2型糖尿病家族史人群不同遗传背景、遗传强度下的胰岛素分泌和胰岛素敏感性特点。方法对2016年12月至2017年2月上海多个社区血糖正常的居民进行流行病学调查问卷、体格检查以及口服葡萄糖耐量试验(OGTT),测定静脉血糖、胰岛素水平,根据稳态模型法(HOMA)及胰岛素敏感性指数(Gutt-ISI)评估胰岛素分泌及敏感性。结果 (1)292例上海市居民中2型糖尿病发生率为6.51%(19例)、空腹血糖受损(IFG)及糖耐量异常(IGT)发生率为12.67%(37例)。(2)2型糖尿病家族史阳性的男性及女性人群,其胰岛素敏感性较无家族史人群降低(HOMA-IS:男性0.52±0.17对0.54±0.28,女性0.59±0.30对0.69±0.33,P=0.04),胰岛B细胞分泌功能较无家族史人群升高显著(HOMA-β:男性190.6±130.31对142.58±76.06,女性157.84±96.68对120.87±74.71,P=0.02)。(3)在同胞2型糖尿病遗传背景人群的胰岛素敏感性及胰岛B细胞分泌功能较其他父系、母系、双系等遗传背景者改变具有统计学差异(P<0.05),且胰岛素敏感性减退与糖尿病遗传背景呈负相关,HOMA-β水平呈正相关(P<0.05)。结论有2型糖尿病家族史人群其在早期血糖正常时,即出现胰岛素敏感性下降,以同胞遗传背景为著,且胰岛素敏感性减退程度随遗传强度增加而递减,胰岛B细胞通过代偿性分泌以维持其血糖正常。
Objective To assess the status of glucose metabolism in Shanghai residents and to observe the characteristics of insulin secretion and insulin sensitivity in different genetic backgrounds, genetic strength of type 2 diabetes family history population. Methods The epidemiological questionnaire, physical examination and oral glucose tolerance test (OGTT) were conducted in residents of multiple communities in Shanghai from December 2016 to February 2017. Venous blood glucose and insulin levels were measured. According to the steady state model HOMA) and insulin sensitivity index (Gutt-ISI) to assess insulin secretion and sensitivity. Results (1) The incidence of type 2 diabetes in Shanghai residents was 6.51% (29 cases) in 292 Shanghai residents. The incidence of impaired fasting glucose (IGGG) and impaired glucose tolerance (IGT) was 12.67% (37 cases). (2) The male and female with positive family history of type 2 diabetes had lower insulin sensitivity than those without family history (HOMA-IS: 0.52 ± 0.17 vs 0.54 ± 0.28 for males and 0.59 ± 0.30 vs 0.69 ± 0.33 for females, P = 0.04). The secretion of islet B cells was significantly higher than that of the non-family history subjects (HOMA-β: 190.6 ± 130.31 vs 142.58 ± 76.06, 157.84 ± 96.68 vs 120.87 ± 74.71, P = 0.02). (3) There was a significant difference (P <0.05) in insulin sensitivity and islet B cell secretion in siblings with genetic backgrounds of type 2 diabetes mellitus compared with those in other paternal, maternal and pedigree backgrounds (P <0.05), and insulin sensitivity and The genetic background of diabetes was negatively correlated with HOMA-β level (P <0.05). CONCLUSIONS: Patients with family history of type 2 diabetes mellitus experience insulin sensitivity decline in early stage of normal blood glucose, with sibling genetic background, and the degree of insulin sensitivity decline with the increase of genetic strength, pancreatic islet B cells through compensatory secretion To maintain its normal blood sugar.