肥胖对不同糖耐量者第一时相胰岛素分泌功能的影响

 目的： 探讨肥胖对不同糖耐量人群第一时相胰岛素分泌功能的影响。方法： 无糖尿病家族史的正常糖耐量者(正常对照，NC)38例、2型糖尿病一级亲属正常糖耐量(NGT)者32例、糖调节受损(IGR)者67例及新诊断的2型糖尿病(T2DM)患者35例参与本试验。这4个组再分为超重/肥胖及正常体重2个亚组。各组均行静脉葡萄糖耐量试验（IVGTT）和口服葡萄糖-胰岛素释放试验（OG-IRT），计算第一时相胰岛素分泌功能指数(AlR3-5)及胰岛素敏感性指数（ISI），分析肥胖对不同糖耐量人群胰岛β细胞功能及胰岛素抵抗的影响。结果： NC超重/肥胖亚组较正常体重亚组AIR3-5显著升高（P<0.05），其余3对亚组间比较差异均无统计学意义（均P>0.05）。超重/肥胖亚组ISI较正常体重亚组有降低趋势，其中IGR两亚组间比较差异无统计学意义（P>0.05），其余3对亚组间比较差异均有统计学意义（均P<0.05）。ISI与体重指数和腰围在各组均呈负相关（P<0.05），与AIR3-5在NC组呈负相关（P<0.05），而在其余各组均呈正相关（均P<0.05）。结论： 肥胖对不同糖耐量人群胰岛β细胞分泌功能影响各不相同。无糖尿病家族史的正常糖耐量者随着胰岛素抵抗的加重，第一时相胰岛素分泌功能代偿性增加，而2型糖尿病一级亲属正常糖耐量者、糖调节受损者和2型糖尿病患者则不能代偿性增加。

Influence of obesity on the function of first-phase insulin secretion in individuals with different glucose tolerance

AIM: To explore the influence of obesity on the function of first-phase insulin secretion in individuals with different glucose tolerance. METHODS: 38 normal glucose tolerance subjects without family history of diabetes (NC) and 32 normal glucose tolerance (NGT) subjects Who were first-degree relatives of type 2 diabetes , 67 impaired glucose regulation (IGR) and 35 newly-diagnosed type 2 diabetic patients (T2DM) were recruited in the study. Four groups were divided into two subgroups : overweight/obesity and normal weight subgroups. All subjects received Oral glucose-insulin release test (OG-IRT) and intravenous glucose tolerance test (IVGTT). AIR3-5 was to reflect first-phase insulin secretion function, SIM was to reflect insulin sensitivity. AIR3-5 and SIM were calculated To analyze the relationship between obesity and isletβ-cell function and insulin sensitivity in individuals with different glucose tolerance. RESULTS: The levels of the AIR3-5 of the subjects of overweight/obesity with normal glucose tolerance without family history of diabetes were significantly higher than those of normal weight subgroups of NC.（P <0.05）; while there was no significant difference between other subgroups（P >0.05）. There was no significant difference of the levels of the SIM between the patients of IGR with overweight/obesity subgroups and normal weight subgroups（P >0.05）, while in other 3 groups overweight/obesity subgroups were lower than those of normal weight subgroups（P <0.05）. SIM was negatively correlated with BMI and waist circumference in all groups（P <0.05）, while SIM was positively correlated with AIR3-5 in NC and negatively correlated in other 3 groups（P <0.05）. CONCLUSION : The impact of obesity on insulin secretion was not the same in the subjects with different glucose tolerance. With the aggravation of insulin resistance, the first-phase insulin secretion of the subjects with normal glucose tolerance without family history of diabetes compensatory increased; while the normal glucose tolerance subjects who were first-degree relatives of type 2 diabetes and impaired glucose regulation and type 2 diabetic patients could not compensatory increase.