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目的比较单纯糖耐量受损者(I-IGT)和空腹血糖受损并糖耐量受损者(IFG+IGT)的内皮功能及代谢异常。方法根据2005年国际糖尿病联盟标准男性腰围≥90 cm、女性腰围≥80 cm为肥胖,分肥胖组与非肥胖组,选择2008年1月~2012年3月钦州市第二人民医院体检人员,包括I-IGT(D组)83例(非肥胖即D1组41例,肥胖即D2组42例)和IFG+IGT(E组)72例(非肥胖即E1组30例,肥胖即E2组42例),以正常糖耐量者(N组)142例(非肥胖即N1组75例,肥胖即N2组67例)作对照,采用口服葡萄糖耐量试验及胰岛素释放试验检测血糖、免疫活性胰岛素,同时检测空腹血脂、游离脂肪酸(FFA)、脂联素(APN)、超敏C反应蛋白(hs-CRP)、内皮素(SET),留取晨尿测定内皮素(UET)、尿微量白蛋白(MUA)。测量腰围、血压、身高和体质量。计算平均动脉压(MAP)、血糖曲线下面积(glu AUC)、10~30 min胰岛素净增值与血糖净增值的比值(ΔI/ΔG)、β细胞功能指数(HOMA-β)和胰岛素抵抗指数(HOMA-IR)等。结果校正性别、年龄后,E组与D组、E2组与D2组的hs-CRP、MUA、SET、UET比较,差异有统计学意义(P<0.05或P<0.01);E1组与D1组的UET比较,差异有统计学意义(P<0.05);E组与D组的三酰甘油(TG)、高密度脂蛋白胆固醇(HDL)、FFA、APN、空腹血糖(FPG)、糖耐量2 h血糖(2 h PG)、glu AUC、ΔI30/ΔG30、ΔI20/ΔG20、ΔI10/ΔG10、HOMA-β和HOMA-IR比较,差异有统计学意义(P<0.05或P<0.01);E1组与D1组的TG、HDL、FFA、APN、FPG、glu AUC、HOMA-IR、HOMA-β、ΔI30/ΔG30、ΔI20/ΔG20、ΔI10/ΔG10比较,差异有统计学意义(P<0.05或P<0.01);E2组与D2组的MAP、TG、HDL、FFA、APN、HOMA-IR、HOMA-β、FPG、2 h PG、glu AUC、ΔI20/ΔG20和ΔI10/ΔG10比较,差异有统计学意义(P<0.05)。结论与I-IGT比较,IFG+IGT内皮损害更严重,肥胖者大血管和微血管均加重,非肥胖者微血管加重明显;IFG+IGT肥胖者血压增高更明显,TG和FFA增高,HDL和APN降低;无论肥胖与否,血糖紊乱更重且胰岛功能下降,特别是早期相的下降及胰岛素抵抗更明显。
Objective To compare the endothelial dysfunction and metabolic abnormalities in patients with impaired glucose tolerance (I-IGT) and impaired fasting glucose (IGG) and impaired glucose tolerance. Methods According to the 2005 International Diabetes Federation criteria male waist circumference ≥ 90 cm, female waist circumference ≥ 80 cm for obesity, obese group and non-obese group, select January 2008 ~ March 2012 Qinzhou Second People’s Hospital medical staff, including There were 83 cases of I-IGT (D group), 41 cases of non-obese group (D1), 72 cases of obesity (D2 group) and 72 cases of IFG + IGT group ), 142 patients with normal glucose tolerance (N group) (75 non-obese group N1, obesity or N2 group, 67 cases) as a control, oral glucose tolerance test and insulin release test for blood glucose, immune active insulin, simultaneous detection Fasting blood lipids, free fatty acids (FFA), adiponectin (APN), hs-CRP, SET, UET and MUA ). Measuring waist circumference, blood pressure, height and weight. The mean arterial pressure (MAP), the area under the curve of glucose (glu AUC), the net insulin added value and the net added blood glucose value (ΔI / ΔG), β cell function index (HOMA-β) and insulin resistance index HOMA-IR) and so on. Results There were significant differences in hs-CRP, MUA, SET and UET between groups E and D, E2 and D2 (P <0.05 or P <0.01) (P <0.05). The triglyceride (TG), high density lipoprotein cholesterol (HDL), FFA, APN, fasting blood glucose (FPG), glucose tolerance 2 (P <0.05 or P <0.01). There was a significant difference between group A and group B (P <0.05) The differences of TG, HDL, FFA, APN, FPG, glu AUC, HOMA-IR, HOMA-β, ΔI30 / ΔG30, ΔI20 / ΔG20 and ΔI10 / ΔG10 in group D1 were statistically significant (P <0.05 or P <0.01 ). The differences of MAP, TG, HDL, FFA, APN, HOMA-IR, HOMA-β, FPG, 2 h PG, glu AUC, ΔI20 / ΔG20 and ΔI10 / ΔG10 between E2 group and D2 group were statistically significant P <0.05). Conclusion Compared with I-IGT, endothelial damage of IFG + IGT is more serious. The macrovascular and microvascular are more serious in obese subjects than those in non-obese subjects. The increase of blood pressure in obese IFG + IGT patients is more obvious. The levels of TG and FFA are higher and HDL and APN are lower ; Whether obesity or not, more severe glucose disorders and decreased islet function, especially the decline of early phase and insulin resistance is more obvious.