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目的评估初发的单纯空腹血糖受损(iIFG)和单纯空腹高血糖型糖尿病(IFH)患者的胰岛素分泌及胰岛素敏感性特征,进一步探讨进展为 IFH 的相关因素。方法 2004-2005年瑞金医院内分泌科门诊初诊病人,隔夜空腹10h 后行口服葡萄糖耐量试验,其中同时行胰岛素释放试验1852例。其中糖耐量正常(NGT)557例;iIFG 221例;IFH 81例。比较各组的代谢指标及胰岛素分泌和胰岛素敏感性指数。结果对1852例接受者操作特征曲线(ROC)分析确定的糖耐量异常(除外糖尿病)发生的最佳空腹血糖切点为5.590mmol/L,2型糖尿病发生的最佳空腹血糖切点为6.695mmol/L。从 NGT→iIFG→IFH,早期相胰岛素分泌和胰岛素敏感性指数均逐渐降低。结论初发的iIFG 和 IFH 均有显著的早期相胰岛素分泌缺陷和胰岛素敏感性降低。β细胞胰岛素分泌缺陷和胰岛素抵抗均是从 NGT 向 iIFG 向 IFH 的进展过程中的重要因素。
Objective To evaluate the insulin secretion and insulin sensitivity of newly diagnosed patients with impaired fasting blood glucose (iIFG) and simple fasting hyperglycemia (IFH), and further explore the related factors of progression to IFH. Methods The first visit of endocrinology clinic in Ruijin Hospital from 2004 to 2005 was performed oral glucose tolerance test 10h after fasting overnight. Among them, 1,852 patients were simultaneously given insulin release test. Including normal glucose tolerance (NGT) 557 cases; 221 cases of iIFG; IFH 81 cases. Metabolic parameters and insulin secretion and insulin sensitivity index of each group were compared. Results The optimal fasting plasma glucose (LCT) cutoff point (5.590 mmol / L) for type 2 diabetes mellitus (T2DM) was 6.695 mmol / L for the 1852 ROC analysis of impaired glucose tolerance / L. From NGT → iIFG → IFH, the early phase insulin secretion and insulin sensitivity index decreased gradually. Conclusions Initial iIFG and IFH both have significant defects in early phase insulin secretion and decreased insulin sensitivity. Beta-cell insulin secretion deficiencies and insulin resistance are important factors in progression from NGT to iIFG to IFH.