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目的调查成都地区2型糖尿病患者糖耐量正常一级亲属的代谢状态及与胰岛素抵抗、胰岛β细胞功能的相关性。方法 2007年7 9月共纳入糖耐量正常的一级亲属312例(NGT-FDR组),无家族史的正常对照1 348例(NGT-C组)。测量两组血压、体重、腰围;检测口服葡萄糖耐量试验(OGTT)中0、0.5、2h血糖、胰岛素水平;测定空腹血脂;计算体重指数、HOMA-胰岛素抵抗指数(HOMA-IR)、胰岛β细胞功能指数(HOMA-β),β细胞早相分泌功能指数(△I30/△G30),并比较两组间上述指标的差异和代谢综合征(MS)及其各组分的发病情况。结果①NGT-FDR组MS发生率高于NGT-C组,发生MS的风险是后者的1.737倍。NGT-FDR组高甘油三酯血症(hypertriglyceridemia,HTG)、空腹血糖偏高(5.6～6.0mmol/L)的发生率高于NGT-C组,合并4种及以上代谢异常的几率亦高于NGT-C组(P<0.05);②年龄<40岁的NGT-FDR中心性肥胖、HTG、空腹血糖偏高和MS均高于同年龄对照;男性NGT-FDR空腹血糖偏高和MS发病率高于男性对照(P<0.05);③腰围、收缩压(SBP)、空腹血糖(FBG)、甘油三酯(TG)及糖尿病家族史同HOMA-IR呈正相关。腰围、SBP、TG及糖尿病家族史同HOMA-β呈正相关,FBG则同HOMA-β呈负相关。结论 2型糖尿病糖耐量正常一级亲属比无家族史的对照表现出更多的代谢异常,尤其是在年龄<40岁及男性中。各种代谢异常可加重胰岛素抵抗,影响胰岛基础分泌功能。故有必要对糖耐量正常的一级亲属进行各项代谢指标的监测和早期预防性干预。
Objective To investigate the metabolic status of insulin resistance and pancreatic β-cell function in type 2 diabetic patients with normal glucose tolerance in Chengdu. Methods A total of 312 first-degree relatives with normal glucose tolerance (NGT-FDR group) and 1348 normal controls without family history (NGT-C group) were enrolled in this study. The blood pressure, body weight and waist circumference of the two groups were measured. The blood glucose and insulin levels at 0, 0.5, and 2h were measured in oral glucose tolerance test (OGTT). The fasting blood lipids were measured. The body mass index, HOMA-IR, HOMA-β, △ I30 / △ G30, and the difference of these indexes and the incidence of metabolic syndrome (MS) and its components between the two groups were compared. Results ① The incidence of MS in NGT-FDR group was higher than that in NGT-C group, and the risk of developing MS was 1.737 times of the latter. The incidence of hypertriglyceridemia (HTG) and high fasting blood glucose (5.6-6.0 mmol / L) in NGT-FDR group was higher than that in NGT-C group, and the odds of combining 4 or more metabolic abnormalities were also higher NGT-C group (P <0.05) .②The NGT-FDR central obesity, HTG, fasting blood glucose and MS were higher than those of the same age in the group of <40 years old. (P <0.05). ③The family history of waist circumference, systolic blood pressure (SBP), fasting blood glucose (FBG), triglyceride (TG) and diabetes were positively correlated with HOMA-IR. Waist circumference, SBP, TG and family history of diabetes were positively correlated with HOMA-β, while FBG was negatively correlated with HOMA-β. CONCLUSIONS: Type 2 diabetic patients with normal glucose tolerance have more metabolic abnormalities than controls without family history, especially in patients <40 years of age and in men. A variety of metabolic disorders can exacerbate insulin resistance, affecting the basal secretion of pancreatic islets. Therefore, it is necessary to carry out monitoring of various metabolic indexes and early preventive intervention on first-degree relatives with normal glucose tolerance.