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目的探讨酮症起病糖尿病(KPD)患者BMI对胰岛素分泌和IS的影响。方法将131例自发KPD患者根据BMI分为体重正常(Con)组、超重(Ow)组和肥胖(Ob)组。比较3组胰岛β细胞功能指数(HOMA-β)和胰岛素抵抗指数(HOMA-IR)等指标,并对其中50例进行随访,观察胰岛素功能的变化。结果与Con组随访患者比较,Ob组随访患者治疗后HOMA-β差值[8.28(-1.65,33.50)vs33.85(23.22,49.11)]升高,HOMA-IR差值[(0.84±1.62)vs(0.38±1.56)]降低(P<0.05)。单相关分析显示,HOMA-β与BMI呈正相关(r=0.642,P<0.01)。校正IR、年龄、高血压、脂肪性肝病患病率、TG、TC、LDL-C等影响因素后,HOMA-β仍与BMI呈正相关(r=0.278,P=0.022)。多元线性回归分析结果显示,治疗前lnHOMA-β与HbA1c、BMI、lnHOMA-IR相关,治疗后与BMI相关。结论 BMI可作为简单可行的胰岛功能预测方法。
Objective To investigate the effect of BMI on insulin secretion and IS in patients with ketosis-onset diabetes mellitus (KPD). Methods 131 cases of spontaneous KPD patients were divided into normal weight (Con) group, Obese group (Ob) and Ob group according to BMI. The indexes of HOMA-β and HOMA-IR of three groups were compared, and 50 of them were followed up to observe the change of insulin function. Results Compared with the Con group, the HOMA-β difference [8.28 (-1.65,33.50) vs33.85 (23.22,49.11)] and HOMA-IR difference [(0.84 ± 1.62) vs (0.38 ± 1.56)] (P <0.05). Single correlation analysis showed that there was a positive correlation between HOMA-β and BMI (r = 0.642, P <0.01). HOMA-β was still positively correlated with BMI (r = 0.278, P = 0.022) after adjusting for IR, age, hypertension, prevalence of fatty liver disease, TG, TC and LDL-C. Multivariate linear regression analysis showed that lnHOMA-β was associated with HbA1c, BMI and lnHOMA-IR before treatment and BMI after treatment. Conclusion BMI can be used as a simple and feasible method for predicting islet function.