女性肥胖和2型糖尿病患者高葡萄糖钳夹过程中胰岛素原的分泌和释放

目的 探讨女性肥胖和2型糖尿病患者在持续高糖情况下胰岛素原分泌和释放的变化.方法 12例肥胖、7例2型糖尿病和9例正常对照组,行150分钟高葡萄糖钳夹试验,用酶联免疫法测定各时点胰岛素原.结果 肥胖组和2型糖尿病组空腹胰岛素原(PI)水平高于对照组.2型糖尿病组在10～150分钟期间胰岛素原/胰岛素比值高于肥胖组和对照组.Spearman相关分析显示,PI与胰岛素原分泌第一时相(FPPR)(r=0.464,P=0.026)和内脏脂肪(VA)(r=0.447,P=0.033)呈正相关;与葡萄糖代谢清除率(GDR)(r=-0.533,P=0.009)呈负相关.结论 胰岛素原分泌与胰岛素抵抗密切相关.持续高糖情况下肥胖患者由于胰岛素抵抗代偿性高分泌胰岛素原,2型糖尿病患者存在胰岛功能损害,胰岛素原分泌降低,而且胰岛素原转换胰岛素过程中存在缺陷.

The secretion and release of plasma proinsulin in female patients with obese or type 2 diabetes mellitus during the hyperglycemic clamp

Objective To investigate the changes of plasma proinsulin during hyperglycemic clamp in obese or type 2 diabetes women.Methods 12 obesity(Obse),7 type 2 diabetes mellitus(T2DM) and 9 control subjects(Control) were conducted by hyperglycemic clamp test.Plasma proinsulin was assayed by ELISA.Results Obse and T2DM group had higher fasting plasma proinsulin (PI)level than Control group.The level of ratio of proinsulin to immunoreactive insulin was significantly higher in T2DM group than Obse and Control group during 10 minutes to 150 minutes hyperglycemic clamp.Spearman correlation analysis showed that PI was positively correlated to first phase proinsulin release(FPPR) (r=0.464,P=0.026) and visceral adipose area (VA)(r=0.447,P=0.033) and negatively correlated to glucose disposal rates (GDR)(r=-0.533,P=0.009).Conclusions The level of PI was positively correlated to insulin resistance.During hyperglycemic clamp test,Obesity female secreted more proinsulin because of existed insulin resistance,meanwhile T2DM group had lower proinsulin and the higher ratios of proinsulin to insulin because of beta-cell disfunction.