2型糖尿病伴原发性高血压患者的胰岛素抵抗的研究

目的研究2型糖尿病伴原发性高血压(T2DM EH)患者的胰岛功能及胰岛素抵抗.方法应用BA-ELISA法测定96例正常糖耐量(NGT)、132例T2DM和148例T2DM EM三个实验组的血清真胰岛素(TI)水平,并计算出胰岛素敏感性指数(IAI)、胰岛素抵抗指数(HomalIR)和β细胞功能指数(HBCI).结果IAI分别为-2.44±0.83,-3.46±0.99和-3.98±0.68;HBCI分别为4.23±0.18,2.39±0.11和2.41±0.14;HomalIR分别为-0.67±0.83,0.35±0.99和0.86±0.68.T2DM及T2DM EH组IAI、HBCI均低于NGT组,经协方差分析,差异具有非常显著性(P＜0.01),HomalIR明显高于NGT组,且差异具有非常显著性(P＜0.01).T2DM EH组IAI低于T2DM组,差异有显著性(P＜0.05),HomalIR高于T2DM组且差异有显著性(P＜0.05),T2DM、T2DM EH二组间HBCI差异无显著性(P＞0.05).结论2型糖尿病伴原发性高血压较单纯2型糖尿病胰岛素抵抗加重,胰岛素敏感性减低,而胰岛素β细胞分泌功能损害并无加重.

Characteristics of insulin secretion and insulin resistance in subjects of type 2 diabetes with essential hypertension

Objective: To research the characteristics of insulin secretion and insulin resistance (IR) in subjects of type 2 diabetes with essential hypertension. Method: The fasting serum true insulin (TI) were determined with BA-ELISA method, fasting serum immunoreactive insulin(IRI) with radioimmunoassay, fasting plasma glucose (FPG) with enzyme method in 96 subjects of impaired glucose tolerance (NGT), 132 subjects of type 2diabetes(T2DM) and 148 subjects of T2DM with essential hypertension(T2DM+EH), who did not undergone any antihypertensive treatments in two weeks. On the basis of FPG and TI or IRI, insulin secretion index (HBCI)and insulin resistance level (including Homa model insulin resistance index - IR and insulin sensitivity indexIAI ) were calculated. Results: There were significant differences in body mass index (BMI) among the three groups. TI value was higher in subjects with T2DM than that in subjects with NGT, but there was no significance between T2DM and NGT (P＞0.05). Subjects in T2DM+EH had higher TI level than those in T2DM and NGT, and there was significant difference among the three groups (P＜0.05). Other indexes were as follows: IAI -2.44±0.83 (NGT), -3.46±+0.99 (T2DM) and -3.98±+0.68 (T2DM+EH). HBCI 4.23±0.18(NGT), 2.39±0.11 (T2DM)and 2.41±+0.14 (T2DM+EH). HomaIR -0.67±+0.83 (NGT), 0.35±0.99 (T2DM) and 0.86±0.68(T2DM+EH). IAI and HBCI in T2DM and T2DM+EH groups were lower than those in NGT, and the differences were significant.HomaIR in T2DM and T2DM+EH groups was higher than those in NGT group, and the difference was significant. IAI in T2DM+EH group was significantly lower than that in T2DM group. HomaIR in T2DM+EH group was significantly higher than that in T2DM group. HBCI in T2DM+EH group was higher than that in T2DM group, but the difference was not significant. Conclusion: Insulin resistance is more serious and insulin sensitivity is lower in subjects of type 2 diabetes with essential hypertension than those in type 2 diabetes, while insulin secretion is not more serious in type 2 diabetes with essential hypertension.