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目的评价正常糖耐量(NGT)、糖调节受损(IGR)、新诊断2型糖尿病(T2DM)个体胰岛β细胞功能及其相关指标的适用性。方法 178例入选者行口服和静脉葡萄糖耐量试验。检测胰岛素生成指数(ΔI_(30)/ΔG_(30))、胰岛素急性分泌时相(AIR)、β细胞功能指数(HOMA β)、空腹胰岛素原(FPI)及胰岛素原/胰岛素(PI/I)比值反映胰岛素分泌功能。结果 IGR 组的ΔI_(30)/ΔG_(30)、AIR 较 NGT组分别下降了38%、39%,HOMA β轻度下降(19%);T2DM 组的胰岛β细胞功能降低更明显,其中AIR 下降84%,ΔI_(30)/ΔG_(30)下降70%、HOMA β下降62%。T2DM 组 FPI 和 PI/I 比值也比 NGT 组明显升高(24.4 pmo/L±18.0 pmol/L or 10.9 pmol/L±6.7 pmol/L;14.7%±10.5%or10.0%±6.5%,P<0.05)。ΔI_(30)/ΔG_(30)和 AIR 相关性好(r=0.75,P<0.001)。结论 IGR 患者主要表现胰岛素分泌时相缺陷和 HOMA β降低,至糖尿病阶段则伴有胰岛素分泌质量下降。ΔI_(30)/ΔG_(30)和AIR 均可准确反映 IGR 患者胰岛β细胞功能,而在新诊断2型糖尿病患者中 AIR 更适用,若应用ΔI_(30)/ΔG_(30)须校正胰岛素抵抗。
Objective To evaluate the applicability of normal glucose tolerance (NGT), impaired glucose regulation (IGR) and islet β-cell function in newly diagnosed type 2 diabetes mellitus (T2DM) individuals and their related indicators. Methods 178 subjects were enrolled in oral and intravenous glucose tolerance test. Insulin production index (ΔI_ (30) / ΔG_ (30)), acute phase of insulin secretion (AIR), beta cell function index (HOMA beta), fasting plasma proinsulin (FPI) and proinsulin / The ratio reflects the insulin secretion function. Results Compared with NGT group, the AI of IGR group decreased by 38% and 39%, while that of HOMA β decreased slightly (19%). The decrease of islet β-cell function in T2DM group was more obvious Decreased by 84%, ΔI_ (30) / ΔG_ (30) decreased by 70% and HOMA β decreased by 62%. The ratio of FPI and PI / I in T2DM group was significantly higher than that in NGT group (24.4 pmo / L ± 18.0 pmol / L or 10.9 pmol / L ± 6.7 pmol / L; 14.7% ± 10.5% or10.0% ± 6.5% <0.05). ΔI_ (30) / ΔG_ (30) had good correlation with AIR (r = 0.75, P <0.001). Conclusion The IGR patients mainly show the phase defect of insulin secretion and the decrease of HOMA β, and the decrease of insulin secretion quality in the stage of diabetes mellitus. ΔI_ (30) / ΔG_ (30) and AIR accurately reflect the function of islet β cells in patients with IGR, but AIR is more suitable in patients with newly diagnosed type 2 diabetes. If ΔI_ (30) / ΔG_ (30) .