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目的评估酮症倾向的初发糖尿病(KPD)患者外周胰岛素敏感性和胰岛B细胞功能。方法对21例酮症起病、自身抗体阴性的糖尿病患者(A组)及24例无酮症的初诊2型糖尿病患者(B组),应用胰岛素治疗3个月。计算治疗前后稳态模型评估的胰岛素抵抗指数(HOMA-IR)、胰岛素敏感性指数(HOMA-ISI)和胰岛素分泌指数(HOMA-IS)。结果治疗前A组HOMA-IS、HOMA-IR较B组低(分别P<0.05和P<0.01);两组HOMA-IR均高于对照组(P<0.01)。治疗3个月后,A组HOMA-IS仍低于B组(P<0.01),两组较治疗前均上升(均P<0.01),治疗前后ΔHOMA-IS两组无统计学差异;A、B两组HOMA-IR无统计学差异,A组ΔHOMA-IR小于B组(P<0.05)。结论酮症起病的糖尿病患者胰岛素抵抗较普通2型糖尿病轻,酮症控制后胰岛素敏感性恢复程度小。
Objective To assess peripheral insulin sensitivity and islet B cell function in patients with ketosis-prone primary diabetes mellitus (KPD). Methods Twenty-one patients with onset of ketosis, autoimmune-negative diabetes mellitus (group A) and 24 patients with newly diagnosed type 2 diabetes without ketosis (group B) were treated with insulin for 3 months. The HOMA-IR, HOMA-ISI and HOMA-IS were calculated before and after treatment. Results HOMA-IS and HOMA-IR in group A before treatment were lower than those in group B (P <0.05 and P <0.01, respectively). HOMA-IR in both groups was significantly higher than that in control group (P <0.01). After 3 months of treatment, HOMA-IS in group A was still lower than that in group B (P <0.01), and both groups were higher than those before treatment (all P <0.01). There was no significant difference between the two groups before and after treatment; There was no significant difference in HOMA-IR between the two groups (P <0.05). The ΔHOMA-IR in group A was less than that in group B (P <0.05). Conclusions The onset of ketosis in patients with insulin resistance is lower than that of normal type 2 diabetes and the degree of insulin sensitivity recovery after ketosis control is small.