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目的评价糖调节受损合并高胰岛素血症患者的胰岛功能,分析其影响因素。方法选取北京地区中老年男性共计547例,行75g口服葡萄糖耐量(OGTT)试验,根据美国糖尿病协会(ADA)2003年标准分为三组:空腹血糖受损(IFG)325例、糖耐量减低(IGT)126例和空腹血糖受损合并糖耐量减低(IFG/IGT)96例;各组根据胰岛素测定结果再分为高胰岛素血症组(HINS)以及非高胰岛素血症组(非HINS),对比各组间的代谢特征、胰岛素抵抗和胰岛β细胞分泌功能,评估合并代谢综合征相关疾病的差异。结果 1高胰岛素血症患者IFG组和IFG/IGT组的胰岛素抵抗指数(HOMA–IR)分别是IGT组的1.42倍和1.41倍(P<0.05);非HINS人群胰岛素抵抗情况与之类似:2高胰岛素血症患者胰岛分泌功能IFG/IGT组受损最为严重,其HOMAβ细胞功能指数(HBCI)分别是IGT和IFG组的74.04%和80.98%(P<0.05);经HOMA-IR校正后,与IGT组的显著性差异更加明显,而与IFG组的差异消失;3三组糖调节受损-高胰岛素血症组合并代谢异常疾病的构成比均较相应非HINS组明显升高;IFG/IGT组合并肥胖、高血压和高脂血症的构成比最高。结论 1高胰岛素合并IFG主要的病理机制为肝脏的胰岛素抵抗;2高胰岛素血症合并IGT基础状态的胰岛分泌功能优于合并IFG者;3高胰岛素血症更易合并多种代谢紊乱,尤其是IFG/IGT患者,需要综合干预。
Objective To evaluate the islet function of patients with impaired glucose regulation and hyperinsulinemia, and to analyze the influencing factors. Methods A total of 547 middle-aged and elderly men in Beijing were enrolled in this study. The 75-g OGTT test was divided into three groups according to the American Diabetes Association (ADA) 2003 standard: impaired fasting glucose (IFG) 325 and impaired glucose tolerance (IGT), 126 cases and impaired fasting glucose (IFG / IGT) in 96 cases. Each group was divided into H INS and non-H INS according to the results of insulin test. Metabolic characteristics, insulin resistance, and pancreatic β-cell secretion were compared between groups to assess the differences associated with metabolic syndrome. Results 1 The insulin resistance index (HOMA-IR) of IFG group and IFG / IGT group were 1.42 times and 1.41 times higher than that of IGT group respectively (P <0.05); insulin resistance of non-HINS group was similar Patients with hyperinsulinemia had the most severe impaired islet secretory function (IFG / IGT), with HOMA β functional index (HBCI) of 74.04% and 80.98% (P <0.05) in IGT and IFG groups respectively. After HOMA-IR correction, Significant difference with IGT group was obvious, and the difference with IFG group disappeared; 3 groups of impaired glucose regulation - hyperinsulinemia combined with metabolic abnormalities were significantly higher than the corresponding non-HINS group; IFG / IGT combined with obesity, hypertension and hyperlipidemia constitute the highest ratio. Conclusions1 The main pathological mechanism of hyperinsuline concomitant IFG is hepatic insulin resistance. 2 The hyperinsulinemia with IGT basal state is superior to that with IFG. 3 Hyperinsulinemia is more likely to combine with various metabolic disorders, especially IFG / IGT patients, need comprehensive intervention.