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目的评价糖调节受损(IGR)不同组分的胰岛素抵抗(IR)和胰岛β细胞功能状况。方法OGTT筛查北京地区无DM史中老年人群,据2003年ADA标准,分为正常糖耐量(NGT)组、空腹血糖受损(IFG)组、糖耐量减低(IGT)组、及IFG合并IGT(IFG+IGT)组,检测各组胰岛素抵抗指数(HO-MA-IR)、胰岛素敏感指数(ISI-Stumvoll)、β细胞功能指数(HBCI/IR)及第一、二时相胰岛素分泌指数。结果(1)IFG组:HOMA-IR显著高于NGT组和IGT组,ISI-Stumvoll高于IGT组(P均<0.05),HBCI/IR显著低于NGT组和IGT组(P<0.05);(2)IGT组:HOMA-IR和HBCI/IR均位于NGT组和IFG组之间,ISI-Stumvoll、第一时相和第二时相胰岛素分泌指数显著低于NGT组和IFG组(P均<0.05);(3)IFG+IGT组:HOMA-IR高于NGT组、IFG组和IGT组,ISI-Stumvoll显著低于NGT组和IFG组(P均<0.05),HBCI/IR显著低于NGT组和IGT组(P均<0.05);(4)在非糖尿病人群中,随着FPG及2hPG的升高,HOMA-IR有递增趋势,ISI-Stumvoll、第一时相和第二时相胰岛素分泌指数有递减趋势(P均<0.05)。结论IFG主要是肝脏IR和基础状态时的胰岛β细胞分泌功能受损。IGT的肌肉IR较重,其糖负荷后的胰岛β细胞分泌功能受损较重。在非糖尿病人群,FPG和2hPG的升高与IR呈正相关,与胰岛β细胞功能呈负相关。
Objective To assess the insulin resistance (IR) and pancreatic β-cell function of different components of impaired glucose regulation (IGR). Methods According to the ADA criteria of 2003, OGTT was used to screen the middle-aged and elderly people without DM in Beijing. The patients were divided into normal glucose tolerance (NGT), impaired fasting glucose (IFG), impaired glucose tolerance (IGT) (IFG + IGT) group. HO-MA-IR, ISI-Stumvoll, HBCI / IR and the first and second phases of insulin secretion index were detected. Results: (1) HOMA - IR in IFG group was significantly higher than that in NGT group and IGT group, and ISI - Stumvoll group was higher than IGT group (P <0.05). HBCI / IR was significantly lower than NGT group and IGT group (P <0.05). (2) IGT group: HOMA-IR and HBCI / IR were located between NGT group and IFG group, ISI-Stumvoll, first phase and second phase insulin secretion index were significantly lower than NGT group and IFG group (P <0.05). (3) HOMA-IR was higher in IFG + IGT group than in NGT group, IFG group and IGT group, while ISI-Stumvoll in IFG + IGT group was significantly lower than that in NGT group and IFG group NGT group and IGT group (all P <0.05). (4) In non-diabetic patients, HOMA-IR increased with the increase of FPG and 2hPG. The ISI-Stumvoll, first phase and second phase Insulin secretion index decreased (P <0.05). CONCLUSIONS: IFG is mainly impaired in hepatic IR and basal state of pancreatic β-cell secretory function. IGT muscle IR heavier, its glucose-loaded pancreatic β-cell secretion impaired. Elevated FPG and 2hPG levels were positively correlated with IR in non-diabetic subjects and negatively correlated with pancreatic β-cell function.