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目的:了解2型糖尿病(T2DM)患者的不同糖耐量非糖尿病一级亲的胰岛素抵抗(IR)和胰岛β细胞功能情况。方法:在重庆地区251个具2个以上T2DM患者的家系中选取195例糖调节异常(FIGR组)和232例糖耐量正常(FNGT组)一级亲及161例糖耐量正常配偶(NC组)进行研究。FIGR组又分为单纯空腹血糖受损(iIFG)、单纯糖耐量低减(iIGT)和联合糖调节受损(IFG/IGT)3个亚组。所有对象行75g口服葡萄糖耐量试验,测定血糖、血脂和胰岛素。用Homa-IR评估胰岛素抵抗,处置指数DI1(Homa-β/Homa-IR)和DI2(△I30/△G30/Homa-IR)分别评估β细胞基础和早期胰岛素分泌功能。结果:⑴校正年龄、性别和BMI后,与NC组比较,FNGT组收缩压和Homa-IR增加,DI1降低(P﹤0.05);FIGR组血压、血脂、血糖、胰岛素及Homa-IR显著升高,而Homa-β、△I30/△G30、DI1及DI2显著下降(P﹤0.01)。⑵与iIFG组比较,iIGT和IFG/IGT组OGTT60min、120min血糖和120min胰岛素水平增加(P﹤0.01);与iIGT组比较,iIFG和IFG/IGT组Homa-IR更高,Homa-β和DI1更低(P﹤0.05);DI2在iIFG、iIGT和IFG/IGT 3组依次降低,IFG/IGT组与前两组比较有显著差别(P﹤0.01)。结论:T2DM家系中非糖尿病一级亲已存在IR和胰岛β细胞功能紊乱。
Objective: To investigate the insulin resistance (IR) and pancreatic β-cell function of non-diabetic first-degree relatives of patients with type 2 diabetes mellitus (T2DM). Methods: 195 cases of abnormal glucose regulation (FIGR group) and 232 primary normal glucose tolerance group (FNGT group) and 161 normal glucose tolerance group (NC group) were enrolled in 251 families with more than two T2DM patients in Chongqing. research. The FIGR group was further divided into 3 subgroups of impaired fasting glucose (iIFG), simple impaired glucose tolerance (iIGT), and impaired glucose regulation (IFG / IGT). All subjects underwent 75 g oral glucose tolerance test, determination of blood glucose, blood lipids and insulin. Insulin resistance was assessed using Homa-IR, and basal and early insulin secretion function was assessed by DI1 (Homa-β / Homa-IR) and DI2 (ΔI30 / ΔG30 / Homa-IR), respectively. Results Compared with NC group, systolic blood pressure and Homa-IR increased, DI1 decreased (P <0.05), and blood pressure, lipids, blood glucose, insulin and Homa-IR in FIGR group were significantly higher than those in NC group after adjusting for age, sex and BMI , While Homa-β, △ I30 / △ G30, DI1 and DI2 decreased significantly (P <0.01). (2) Compared with iIFG group, the levels of OGTT 60min, 120min and 120min insulin in iIGT and IFG / IGT groups increased (P <0.01); Compared with iIGT group, Homa-IR was higher in iIFG and IFG / IGT group (P <0.05). DI2 decreased in iIFG, iIGT and IFG / IGT3 groups, but there was a significant difference between IFG / IGT group and the former two groups (P <0.01). Conclusion: IR and pancreatic β-cell dysfunction exist in non-diabetic first-degree relatives of T2DM pedigrees.