不同体质量指数糖尿病患者胰岛素分泌及胰岛功能的特点

目的 探讨BMI糖尿病患者的胰岛素分泌、胰岛素抵抗及胰岛β细胞功能的差异。方法 按照BMI水平将患者分为正常组（18.5≤BMI＜24，n=132）、超重组（24≤BMI＜28，n=142）、轻度肥胖组（28≤BMI＜30，n=132）及重度肥胖组（BMI≥30，n=65）。按照糖尿病病程将患者分为＜5年（n=157）、5~10年(n=90)及≥10年(n=110)。计算患者BMI，测定血脂、FPG、FINS、HbA1c、血糖及胰岛素水平，计算IS、HOMA-IR、AUCGlu、AUCINS、ΔI30/ΔG30及DI，分析不同BMI亚组糖尿病患者的胰岛素抵抗及胰岛β细胞分泌功能。结果 未校正时，重度肥胖组患者的年龄、FINS、HOMA-IR、AUCINS、DI及ΔI30/ΔG30显著高于正常组、超重组及轻度肥胖组（P＜0.001），而IS及HbA1c水平显著降低（P＜0.01）。与BMI正常组相比，轻、重度肥胖组的TG水平显著增加（P＜0.05），而两组间差异无统计学意义（P>0.05）；不同BMI亚组之间的TC、HDL-C、LDL-C、FPG及AUCGlu差异无统计学意义（P>0.05）。糖尿病病程≥10年患者的BMI、AUCINS、DI及（ΔI30/ΔG30）显著低于＜5年及5~10年（P＜0.001），而3组间的FPG、FINS、HOMA-IR、IS及AUCGlu差异无统计学意义（P>0.05）。校正性别、年龄、糖尿病病程及HbA1c后，与其余3组相比，重度肥胖组的FINS、HOMA-IR、AUCINS、DI及（ΔI30/ΔG30）显著增加，IS水平显著减少（P＜0.001）；4组间的TG（P=0.025）与HDL-C（P=0.028）差异有统计学意义，而TC、LDL-C、FPG及AUCGlu差异无统计学意义（P>0.05）。糖尿病患者BMI与TG、FINS、HOMA-IR、AUCINS、DI及ΔI30/ΔG30正相关，与IS、HbA1c负相关，与TC、LDL-C、HDL-C、FPG及AUCGlu无相关性。结论 2型糖尿病患者随病程增加，其胰岛素分泌及胰岛β细胞功能逐渐减弱但胰岛素敏感性变化不明显；随着BMI增加，其胰岛素敏感性逐渐减弱，胰岛素抵抗程度逐渐加重，胰岛β细胞的代偿及分泌功能显著增强。
Objective To investigate the pancreatic β-cell function and insulin resistance in T2DM patients with different BMI. Methods The patients were divided into 4 groups: normal BMI group(18.5≤ BMI＜24, n=132), overweight group(24≤BMI＜28, n=142), mild obese group(28≤BMI＜30, n=38) and severe obese group(BMI≥30, n=65). There were 157 patients with diabetes duration＜5 years, 90 cases with duration of 5-10 years and 110 patients with duration >10 years. Lipid profile, FPG, FINS, HbA1c and insulin levels were measured; IS, HOMA-IR, AUCGlu, AUCINS, ΔI30/ΔG30, and DI were calculated to evaluate the insulin resistance and beta-cell secretion function. Results The age, FINS, HOMA-IR, AUCINS, DI, and ΔI30/ΔG30 in severe obesity group were significantly higher than those in normal BMI, overweight, and mild obesity groups(P＜0.001), while IS and HbA1c levels were lower significantly(P＜0.01). Patients in mild and severe obese group had significantly higher TG levels compared to normal BMI group, while there was no significant difference between mild and severe obese groups(P>0.05). There were no statistical significances in TC, HDL-C, LDL-C, FPG, and AUCGlu among different BMI subgroups(P>0.05). Patients with diabetic duration >10 years had significantly lower BMI, AUCINS, DI, and ΔI30/ΔG30 than those with duration＜5 years and 5-10 years (P＜0.001), while there were no significant differences in FPG, FINS, HOMA-IR, IS and AUCGlu among the three groups. After adjustment for sex, age, duration of diabetes and HbA1c, the FINS, HOMA-IR, AUCINS, DI, and ΔI30/ΔG30 in severe obesity group