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目的 研究血液流变学改变与胰岛素抵抗及胰岛 β细胞分泌功能的关系 ,探讨抗凝降黏药在糖尿病的治疗价值。方法 2 0 0 1- 0 2 2 0 0 3- 11广东医学院第二附属医院选择伴高黏血症及 (或 )高凝血症的正常糖耐量 (NGT) ,糖耐量减退 (IGT) ,2型糖尿病 (DM)各 80例 ,随机分治疗组及对照组 ,治疗组予抗凝降黏药物治疗。各组治疗前后进行血液流变学 ,血脂 ,口服糖耐量试验及胰岛素释放试验。结果 各组血黏度正常后 ,总胆固醇、甘油三酯、空腹血糖、血糖面积、胰岛素抵抗指数显著降低 (P值分别为 <0 0 1、<0 0 1、<0 0 5、<0 0 5、<0 0 5 ) ;DM组空腹胰岛素、胰岛素面积及胰岛 β细胞基础功能指数显著增高 (P值分别为 <0 0 5、<0 0 1、<0 0 1)。多元逐步回归分析显示 ,各组血脂、血糖面积、胰岛素抵抗指数是影响高黏血症的最重要因素 ,2型糖尿病组高黏血症尙受胰岛素面积及胰岛 β细胞基础功能指数影响。 结论 血液流变学改变伴随胰岛 β细胞基础分泌功能和胰岛素抵抗的变化。抗凝降黏药物可能通过改善 2型糖尿病胰岛素抵抗及胰岛 β细胞分泌功能而促进血糖控制。
Objective To study the relationship between hemorheological changes and insulin resistance and pancreatic β-cell secretion, and to explore the therapeutic value of anticoagulant and decreasing viscosity in the treatment of diabetes mellitus. Methods 2 0 0 1- 0 2 2 0 0 3- 11 NGT, impaired glucose tolerance (IGT), 2 with hyperviscosity and / or hypercapnia in the Second Affiliated Hospital of Guangdong Medical College, 80 cases of diabetes mellitus (DM) were randomly divided into treatment group and control group. The treatment group was treated with anti-coagulation and viscosity reduction drugs. Hemorrheology, blood lipid, oral glucose tolerance test and insulin release test were performed before and after treatment in each group. Results After the blood viscosity of each group was normal, the total cholesterol, triglyceride, fasting blood glucose, blood glucose area and insulin resistance index were significantly decreased (P <0.01, <0.01, <0.05, <0.05 , <0 0 5). The fasting insulin, insulin area and basic function index of pancreatic βcells in DM group were significantly increased (P <0.05, <0.01, <0.01). Multiple stepwise regression analysis showed that the levels of serum lipids, blood glucose and insulin resistance index were the most important factors affecting hyperviscosity in each group. Hyperinsulinemia in type 2 diabetic patients was affected by the area of insulin and basal function index of pancreatic β-cells. Conclusion The changes of hemorheology are accompanied by changes of basal secretion and insulin resistance of islet β cells. Anticoagulant drugs may improve blood glucose control by improving insulin resistance and pancreatic β-cell secretion in type 2 diabetic patients.