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目的:分析不同空腹血糖水平胰岛功能特点及变化趋势。方法:选取南京理工大学社区及江苏高邮地区非确诊糖尿病人群1 068例,标准化问卷、人体测量及生化分析分别获取病史资料、体格特征和生化数据,口服75 g葡萄糖耐量(OGTT)及胰岛素释放试验0、30、120 min分别采血测定血糖、胰岛素水平。Matsuda ISI指数评价胰岛素敏感性,0-30 min和0-120 min胰岛素曲线下面积(AUCINS30和AUCINS120)及其与血糖曲线下面积之比(胰岛素释放指数,INSR30和INSR120)评估β细胞胰岛素分泌能力,INSR30和INSR120与MatsudaISI的乘积作为处置指数(DI30和DI120),反应β细胞相对于胰岛素抵抗的代偿能力。结果:与空腹血糖<4.6 mmol/L相比,在空腹血糖处于4.6-5.6 mmol/L时,INSR30和INSR120已出现显著下降,在空腹血糖≥7.0 mmol/L时AUCINS30和AUCINS120出现显著下降。胰岛素敏感性指标Matsuda ISI随着空腹血糖升高逐渐减低,胰岛素抵抗指数HOMAIR随着空腹血糖升高逐渐增大,处置指数DI30和DI120随着空腹血糖升高稳步减低。体质指数(BMI)分组后,在各种血糖水平,肥胖者胰岛素曲线下面积和释放指数均高于非肥胖者,胰岛素敏感性则低于非肥胖者,处置指数在两者间无差别。结论:在空腹血糖正常高界时胰岛功能已经出现减低,尽管其胰岛素释放量尚可维持在一定水平,但β细胞相对于胰岛素抵抗水平的代偿能力已经出现降低。
OBJECTIVE: To analyze the features and trends of islet function in different fasting blood glucose levels. Methods: A total of 1 068 non-diagnosed diabetic patients in Nanjing University of Science and Technology and in Gaoyou, Jiangsu Province were included in the questionnaire. Standardized questionnaires, anthropometric and biochemical analyzes were performed to obtain medical history data, physical characteristics and biochemical data, oral glucose tolerance test (OGTT) Blood samples were collected at 0,30,120 min for blood glucose and insulin levels. The Matsuda ISI index assessed insulin sensitivity, the area under the insulin curves 0-30 min and 0-120 min (AUCINS30 and AUCINS120) and their ratio to the area under the blood glucose curve (insulin release index, INSR30 and INSR120) to assess β-cell insulin secretion , The product of INSR30 and INSR120 with Matsuda ISI as a treatment index (DI30 and DI120), reflects the compensatory capacity of beta cells relative to insulin resistance. RESULTS: Compared with fasting blood glucose <4.6 mmol / L, INSR30 and INSR120 had a significant decrease when fasting blood glucose was 4.6-5.6 mmol / L, and AUCINS30 and AUCINS120 significantly decreased when fasting blood glucose was ≥7.0 mmol / L. Insulin sensitivity index Matsuda ISI decreased gradually with fasting blood glucose, insulin resistance index HOMAIR increased with fasting blood glucose increased, the treatment index DI30 and DI120 decreased steadily with fasting blood glucose. Body mass index (BMI) group, in a variety of blood glucose levels, obese insulin curve under the area and release index were higher than non-obese, insulin sensitivity was lower than non-obese, the treatment index no difference between the two. CONCLUSION: The function of islets has been reduced in fasting normal blood glucose level. Although its insulin release can be maintained at a certain level, the compensatory capacity of β cells relative to insulin resistance has been reduced.