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目的 了解真胰岛素 (true insulin,TI)和前胰岛素 (proinsulin,PI)在肥胖症和 2型糖尿病患者中的改变 ,了解免疫活性胰岛素 (immunoreactive insulin,IRI)能否准确反映 TI。方法 33例糖耐量正常 (NGT)、2 4例糖耐量减低(IGT)和 5 3例新诊断的 2型糖尿病患者行口服葡萄糖耐量实验 ,并根据体重指数 (BMI)分为肥胖和非肥胖组 ;采用EL ISA方法 (其单克隆抗体能准确区分 TI和 PI)测定 TI和 PI;采用放射免疫方法测定 IRI。结果 NGT肥胖组空腹、餐后 30分钟、6 0分钟和 12 0分钟 TI明显高于 NGT非肥胖组 ,糖尿病非肥胖组餐后 30分钟、6 0分钟 TI明显低于 NGT非肥胖组 ,糖尿病肥胖组空腹及餐后 12 0分钟 TI明显高于 NGT非肥胖组 ,IGT非肥胖组餐后 30分钟 TI明显低于 NGT非肥胖组。 IGT肥胖组餐后 12 0分钟 TI明显高于 NGT非肥胖组。 PI/ IRI在糖尿病非肥胖组和糖尿病肥胖组明显高于NGT非肥胖组。 TI/ IRI在 NGT肥胖组、糖尿病非肥胖组、糖尿病肥胖组和 IGT肥胖组均明显低于 NGT非肥胖组。结论 肥胖者、肥胖的 IGT患者和肥胖的新诊断的 2型糖尿病患者具有高胰岛素血症。2型糖尿病患者具有不成比例的前胰岛素的增高 ,免疫活性胰岛素常常过高估计肥胖者、2型糖尿病和 IGT患者的胰岛素水平。
Objective To investigate the changes of true insulin (TI) and proinsulin (PI) in obesity and type 2 diabetes patients and to find out whether immunoreactive insulin (IRI) can accurately reflect TI. Methods Totally 33 patients with normal glucose tolerance (NGT), 24 patients with impaired glucose tolerance (IGT) and 53 newly diagnosed type 2 diabetes patients underwent oral glucose tolerance test and divided into obesity and non-obese group according to body mass index (BMI) ; ELISA method (the monoclonal antibody can accurately distinguish between TI and PI) determination of TI and PI; using radioimmunoassay IRI. Results The fasting, postprandial 30 min, 60 min and 120 min TI were significantly higher in NGT obesity group than those in NGT non-obese group and those in non-obese diabetic group at 30 min postprandial and 60 min TI were significantly lower than those in non-obese NGT group The fasting group and postprandial TI at 120 minutes were significantly higher than those in non-NGT non-obese group, while IGT non-obese group at 30 minutes postprandial was significantly lower than non-obese NGT group. TI was significantly higher in the IGT obesity group than in the NGT non-obese group at 120 minutes postprandial. PI / IRI was significantly higher in non-obese diabetic group and diabetic obesity group than non-obese NGT group. TI / IRI in NGT obesity group, non-diabetic diabetic group, diabetic obesity group and IGT obesity group were significantly lower than NGT non-obese group. Conclusion Obesity, obese IGT patients and obese newly diagnosed type 2 diabetic patients have hyperinsulinemia. Patients with type 2 diabetes have a disproportionate increase in proinsulin, which often overestimates insulin levels in obese, type 2 and IGT patients.