不同体质量指数糖尿病患者胰岛素分泌及胰岛功能的特点

Pancreatic beta-cell function and insulin resistance in type 2 diabetic patients with different body mass indexes

关键词:  体质量指数  葡萄糖处置指数  胰岛素早期相分泌指数

Key words:  body mass index  glucose disposition index  early-phase insulin secretion index

摘要:

目的 探讨BMI糖尿病患者的胰岛素分泌、胰岛素抵抗及胰岛β细胞功能的差异。方法 按照BMI水平将患者分为正常组（18.5≤BMI＜24，n=132）、超重组（24≤BMI＜28，n=142）、轻度肥胖组（28≤BMI＜30，n=132）及重度肥胖组（BMI≥30，n=65）。按照糖尿病病程将患者分为＜5年（n=157）、5~10年(n=90)及≥10年(n=110)。计算患者BMI，测定血脂、FPG、FINS、HbA1c、血糖及胰岛素水平，计算IS、HOMA-IR、AUCGlu、AUCINS、ΔI30/ΔG30及DI，分析不同BMI亚组糖尿病患者的胰岛素抵抗及胰岛β细胞分泌功能。结果 未校正时，重度肥胖组患者的年龄、FINS、HOMA-IR、AUCINS、DI及ΔI30/ΔG30显著高于正常组、超重组及轻度肥胖组（P＜0.001），而IS及HbA1c水平显著降低（P＜0.01）。与BMI正常组相比，轻、重度肥胖组的TG水平显著增加（P＜0.05），而两组间差异无统计学意义（P>0.05）；不同BMI亚组之间的TC、HDL-C、LDL-C、FPG及AUCGlu差异无统计学意义（P>0.05）。糖尿病病程≥10年患者的BMI、AUCINS、DI及（ΔI30/ΔG30）显著低于＜5年及5~10年（P＜0.001），而3组间的FPG、FINS、HOMA-IR、IS及AUCGlu差异无统计学意义（P>0.05）。校正性别、年龄、糖尿病病程及HbA1c后，与其余3组相比，重度肥胖组的FINS、HOMA-IR、AUCINS、DI及（ΔI30/ΔG30）显著增加，IS水平显著减少（P＜0.001）；4组间的TG（P=0.025）与HDL-C（P=0.028）差异有统计学意义，而TC、LDL-C、FPG及AUCGlu差异无统计学意义（P>0.05）。糖尿病患者BMI与TG、FINS、HOMA-IR、AUCINS、DI及ΔI30/ΔG30正相关，与IS、HbA1c负相关，与TC、LDL-C、HDL-C、FPG及AUCGlu无相关性。结论 2型糖尿病患者随病程增加，其胰岛素分泌及胰岛β细胞功能逐渐减弱但胰岛素敏感性变化不明显；随着BMI增加，其胰岛素敏感性逐渐减弱，胰岛素抵抗程度逐渐加重，胰岛β细胞的代偿及分泌功能显著增强。

Abstract:

Objective To investigate the pancreatic β-cell function and insulin resistance in T2DM patients with different BMI. Methods The patients were divided into 4 groups: normal BMI group(18.5≤ BMI＜24, n=132), overweight group(24≤BMI＜28, n=142), mild obese group(28≤BMI＜30, n=38) and severe obese group(BMI≥30, n=65). There were 157 patients with diabetes duration＜5 years, 90 cases with duration of 5-10 years and 110 patients with duration >10 years. Lipid profile, FPG, FINS, HbA1c and insulin levels were measured; IS, HOMA-IR, AUCGlu, AUCINS, ΔI30/ΔG30, and DI were calculated to evaluate the insulin resistance and beta-cell secretion function. Results The age, FINS, HOMA-IR, AUCINS, DI, and ΔI30/ΔG30 in severe obesity group were significantly higher than those in normal BMI, overweight, and mild obesity groups(P＜0.001), while IS and HbA1c levels were lower significantly(P＜0.01). Patients in mild and severe obese group had significantly higher TG levels compared to normal BMI group, while there was no significant difference between mild and severe obese groups(P>0.05). There were no statistical significances in TC, HDL-C, LDL-C, FPG, and AUCGlu among different BMI subgroups(P>0.05). Patients with diabetic duration >10 years had significantly lower BMI, AUCINS, DI, and ΔI30/ΔG30 than those with duration＜5 years and 5-10 years (P＜0.001), while there were no significant differences in FPG, FINS, HOMA-IR, IS and AUCGlu among the three groups. After adjustment for sex, age, duration of diabetes and HbA1c, the FINS, HOMA-IR, AUCINS, DI, and ΔI30/ΔG30 in severe obesity group significantly increased and IS levels significantly decreased compared to the other three groups (P＜0.001). Moreover, there were significant differences in TG and HDL-C levels, but not in TC, LDL-C, FPG and AUCGlu among the four groups. Correlation analysis showed that BMI was positively correlated with TG, FINS, HOMA-IR, AUCINS, DI and ΔI30/ΔG30 and negatively correlated with IS andHbA1c; while not correlated with TC, LDL-C, HDL-C, FPG and AUCGlu. Conclusion The insulin secretion and pancreatic β-cell function are decreased gradually with the increase of duration of diabetes. In patients with T2DM, the insulin sensitivity is decreased and insulin resistance is increased significantly, as well as functional compensation and insulin secretion is enhanced remarkably with the rising BMI.