首页 | 本学科首页   官方微博 | 高级检索  
检索        

成人糖尿病发生模式的探讨
引用本文:李光伟,王金平,陈川,杨文英,姜亚云,胡泽溪,胡英华,潘孝仁.成人糖尿病发生模式的探讨[J].中华医学杂志,2001,81(15):914-917.
作者姓名:李光伟  王金平  陈川  杨文英  姜亚云  胡泽溪  胡英华  潘孝仁
作者单位:1. 中日友好医院内分泌科 ,
2. 大庆市第一医院心血管病研究室
摘    要:目的:探讨我国成年人糖尿病的发病模式和胰岛素抵抗及β细胞胰岛素分泌功能损害在发病中的作用。方法:对以标准葡萄糖耐量试验筛查诊断的糖耐量减低(IGT)307例和糖耐量正常(NGT)126例(年龄25-74岁)进行6年随访,初访时测定口服糖耐量试验(OGTT)0,60,120min之血糖及血浆胰岛素浓度,每2年重复做OGTT,空腹血糖大于等于7.8mmol/L及/或OGTT试验2h血糖≥11.1mmol/L诊为糖尿病,以t检验,x^2检验及多因素回归分析胰岛素抵抗及β细胞功能对糖尿病发病率的影响。 结果:6年随访中发展为糖尿病的IGT有约70%来自胰岛素抵抗人群,另有约30%糖尿病患者在其IGT阶段并无明显胰岛素抵抗,多因素回归分析结果显示,IGT组基线胰岛 敏感性及胰岛素分泌功能与随访发生糖悄病者呈显著负相关I(OR值为0.41及0.39,P<0.01),在NGT人群中,胰岛素抵抗亚组6年后糖耐量恶化率远高于非胰岛素抵抗组(34.5%比13.4%,P<0.05),多因素逐步回归分析结果仅胰岛素抵抗与糖耐量恶化呈显著正相关(P=0.01),结论:我国大部分成人糖尿病发病呈2个阶段模式;第一阶段从NGT发展为IGT,在此阶段胰岛素抵抗起主要作用;第二阶段从IGT发展为糖尿病,在此阶段胰岛 抵抗和β细胞胰岛素分泌功能受损都起重要作用。β.

关 键 词:糖尿病  非胰岛素依赖型  胰岛素抵抗  DM  胰岛素敏感性  糖耐量
修稿时间:2001年3月12日

Model of development of diabetes mellitus in adult Chinese
Li Guangwei,WANG Jinping,CHEN Chuan,et al..Model of development of diabetes mellitus in adult Chinese[J].National Medical Journal of China,2001,81(15):914-917.
Authors:Li Guangwei  WANG Jinping  CHEN Chuan  
Institution:Department of Endocrinology, China-Japan Friendship Hospital, Beijing 100029, China.
Abstract:OBJECTIVE: To explore the model for development of non-insulin dependent diabetes and the roles of insulin resistance and insulin secretion impairment in the initiation of diabetes in adult Chinese. METHODS: 432 non-diabetics aged 24-74, 126 with normal glucose tolerance (NGT) and 307 with impaired glucose tolerance (IGT), were selected by standard oral glucose tolerance test (OGTT) and plasma insulin concentration measurement in Daqing, Heilongjiang Province, in 1986, and then followed up for six years. OGTT was conducted every two years. The subjects with fasting plasma glucose (FPG) > or = 7.8 mmol/L and/or two hour plasma glucose (PG2h) > or = 11.1 mmol/L were diagnosed as with diabetes. The effect of insulin resistance and insulin secretion at baselie on worsening of glucose tolerance in both NGT and IGT groups were analyzed using SAS software. RESULTS: 70% of DM cases developed from the insulin-resistant IGT subgroup at the end of the study. About 30% of DM cases were not insulin-resistant in their IGT stage. Proportional hazard analysis showed that the baseline PG2h and BMI significantly positively correlated to the development of diabetes during the six years follow-up period (RR = 1.35 and 1.32 respectively, P < 0.01). Dietary and exercise intervention significantly decreased such risk. With these confounders being controlled, baseline insulin sensitivity and insulin secretion index significantly negatively correlated to the development of diabetes in the IGT group (RR = 0.41 and 0.39 respectively, P < 0.01). Incidence of IGT (or DM) in the insulin resistant NGT subgroup was much higher than that in the non-insulin resistant NGT subgroup (34.5% vs 13.4%, P < 0.05), stepwise logistic regression analysis showed that only the baseline insulin sensitivity entered the model and negatively associated to the risk of worsening of glucose tolerance (P < 0.05). CONCLUSION: A two-step model of development of diabetes mellitus is shown among most adult Chinese diabetics. In the first step NGT develops to IGT when insulin resistance play a major role. In the second step, IGT develops to diabetes when both insulin resistance and beta-cell secretion impairment play a major role.
Keywords:Diabetes mellitus  non-insulin-dependent  Insulin-deficiency
本文献已被 CNKI 维普 万方数据 等数据库收录!
设为首页 | 免责声明 | 关于勤云 | 加入收藏

Copyright©北京勤云科技发展有限公司  京ICP备09084417号