北京市部分中老年男性高胰岛素血症患者代谢紊乱及胰岛功能评估

目的 分析中老年男性高胰岛素血症(hyperinsulinemia,HINS)患者的临床特征、胰岛功能及其合并疾病。方法 以北京地区中老年男性为研究对象,根据血浆胰岛素水平分为4组:空腹高胰岛素血症(空腹HINS)、负荷后2 h高胰岛素血症(负荷后HINS)、联合受损(空腹/负荷后HINS)以及非高胰岛素血症(非HINS),对比各组间的代谢特征、胰岛素抵抗和胰岛β细胞分泌功能。所有受试对象均行75 g口服葡萄糖耐量(oral glucose tolerance test,OGTT)试验,根据美国糖尿病协会(American Diabetes Association, ADA)2003年标准再将各组分为糖耐量正常(normal glucose tolerance, NGT)组、糖调节受损(impaired glucose regulation, IGR)组和新诊断糖尿病(newly diagnosis diabetes, NDM)组;评估合并代谢综合征相关疾病的差异。结果 共931名中老年男性纳入本研究,空腹HINS组22例、负荷后HINS组109例、空腹/负荷后HINS组49例以及非HINS组751例。1空腹/负荷后HINS组糖化血红蛋白(glycosylated hemoglobin, HbA1_C)显著高于负荷后HINS组(P <0.01),空腹HINS组介于二者之间;2空腹/负荷后HINS组胰岛素抵抗指数(HOMA-IR)最高,其次为空腹HINS组、负荷后HINS组和非HINS组,4组间两两比较差异有统计学意义(F=344.25,P <0.05);3经HOMA-IR校正后,空腹/负荷后HINS组的HOMAβ细胞功能指数(HBCI/IR)和空腹β细胞功能指数(FBCI/IR)较非HINS组均明显降低(F=5.08,P <0.05);负荷后HINS组FBCI/IR与非HINS组比较,差异无统计学意义;4不同糖耐量高胰岛素血症组合并代谢异常疾病的构成比均较相应正常胰岛素组明显升高(P <0.05);随着糖调节受损程度的逐渐加重,代谢异常的构成比逐渐升高。结论 1空腹与负荷后均表现为高胰岛素血症的患者胰岛素抵抗严重,胰岛功能明显受损,糖代谢紊乱程度重;2空腹胰岛素是高胰岛素血症大规模临床筛查的推荐指标;3高胰岛素血症更易合并多种代谢紊乱,尤其是空腹/负荷后HINS患者,需要综合干预。

Evaluation of metabolic disorders and pancreatic islet function in aged male patients with hyperinsulinemia in Beijing

Objective To analyze the clinical characteristic,pancreatic islet function and concomitant diseases in middle-aged and elderly male hyperinsulinemia patients. Methods Assessed by plasma insulin readouts, middle-aged and elderly male in Beijing were divided into 4 groups: fasting hyperinsulinemia (fasting HINS), two hours afterload hyperinsulinemia (afterload HINS), combined damage (fasting/afterload HINS) and non-hyperinsulinemia (non HINS).Then compare metabolic characteristics, insulin resistance and islet β cell secretory function between these groups. Moreover,assessed by oral glucose tolerance test (OGTT), according to ADA 2003 diagnostic criteria, all the subjects were further divided into 3 groups: normal glucose tolerance (NGT), impaired glucose regulation (IGR), newly diagnosis diabetes (NDM).The difference of combined with metabolic syndrome related diseases were evaluated. ResultsA total of 931 middle-aged men enrolled in this study:fasting HINS group (n=22), afterload HINS group (n=109), fasting / afterload HINS group(n=49) and non-HINS group(n=751). 1HbA1_C readout in the fasting/ afterload HINS group was significantly higher than the afterload HINS group(P <0.01),and fasting HINS group in between.2Among the four groups, the fasting/afterload HINS group showed highest HOMA-IR, followed by fasting HINS group, afterload HINS and non HINS group, and there were significant differences among these four groups(F=344.25,P <0.05). 3After corrected by HOMA-IR, HBCI/IR and FBCI/IR readouts of fasting/afterload HINS group were lower than those of non-HINS group significantly(F=5.08,P <0.05).There were no differences in the level of FBCI/IR between afterload HINS group and non-HINS group. 4The metabolic disorders constituent ratio of hyperinsulinemia(HINS)combined with differences IGR patients were significantly higher than the corresponding non-HINS subgroups(P <0.05). Moreover, with the deterioration of glucose regulation, the ratio of metabolic disorders gradually increased. Conclusion 1Fasting and afterload hyperinsulinemia patients showed more severe insulin resistance, pancreatic islet function was significantly impaired, and glucose metabolism disorder gets deterioration.2Fasting insulin is recommended indicators of hyperinsulinemia in large-scale clinical screening.3Hyperinsulinemia was easier to combine with a variety of metabolic disorders, especially fasting and afterload hyperinsulinemia patients need comprehensive intervention.