肝源性糖尿病患者糖代谢异常和胰岛素抵抗研究

目的探讨肝源性糖尿病(HD)患者的糖代谢异常和胰岛素抵抗(IR)的特点。方法选择HD患者106例(HD组)、2型糖尿病(T2DM)患者98例(T2DM组)和健康对照者115例(对照组),行口服葡萄糖耐量试验(OG-TT)、胰岛素和C肽释放试验,计算胰岛β细胞分泌指数(HOMA-β)和早晚相胰岛素分泌指数(△I30/△G30;AUCI30-120/AUCG30-120)、胰岛素抵抗指数(HOMA-IR)、肝脏胰岛素抵抗指数(HIR)、空腹血糖/空腹胰岛素(FBG/FINS)和胰岛素敏感指数(ISI),并进行比较。结果 T2DM组和HD组患者FBG、FINS和空腹C肽水平显著高于对照组(P<0.05);T2DM组患者FBG水平显著高于HD组(P<0.05),FINS水平显著低于HD组(P<0.05),但2组患者空腹C肽水平比较差异无统计学意义(P>0.05)。HD组和T2DM组患者OGTT 30、60、120、180 min时血糖水平均显著高于对照组(P<0.05);HD组和T2DM组患者OGTT各时间点血糖水平比较差异均无统计学意义(P>0.05)。HD组患者服用葡萄糖后各时点胰岛素和C肽水平显著高于T2DM组(P<0.05)。HD组患者服用葡萄糖后60、120、180 min时胰岛素水平显著高于对照组(P<0.05),HD组患者服用葡萄糖后60 min时血C肽水平低于对照组(P<0.05),但120、180 min时血C肽水平高于对照组(P<0.05)。HD组HOMA-β和AUCI30-120/AUCG30-120和ISI均高于T2DM组(P<0.05);HD组FBG/FINS低于T2DM组(P<0.05),HD组△I30/△G30、HOMA-IR和HIR与T2DM组比较差异均无统计学意义(P>0.05)。结论 HD患者存在明显的IR和高胰岛素血症,以早相胰岛素分泌受损及餐后高血糖为主。

Glucose metabolic abnormalities and insulin resistance in patients with hepatogenic diabetes

Objective To investigate the clinical features of glucose metabolic abnormalities and insulin resistance(IR)in patients with hepatogenic diabetes(HD).Methods One hundred and six patients with HD(HD group),ninety-eight patients with type 2 diabetes mellitus(T2DM group)and one hundred and fifteen healthy people(control group)were chosen in this study.The oral glucose tolerance test(OGTT),insulin and C-peptide release test were carried out,then the islet β-cell secretion index(HOMA-β),early and late phase insulin secretion index(△I30/△G30;AUCI30-120/AUCG30-120),insulin resistance index(HOMA-IR),hepatic insulin resistance(HIR),fasting blood glucose/fasting insuline(FBG/FINS)and insulin sensitivity index(ISI)were calculated and compared among the groups.Results The levels of FBG and FINS in T2DM group and HD group were significantly higher than those in control group(P<0.05).The level of FBG in T2DM group was significantly higher than that in HD group(P<0.05),and the level of FINS in T2DM group was significantly lower than that in HD group(P<0.05),but there was no significant difference in the level of C-peptide between T2DM group and HD group(P>0.05).The levels of blood glucose at the time of OGTT 30,60,120 and 180 minutes in T2DM group and HD group were significantly higher than those in control group(P<0.05).There was no significant difference in the levels of blood glucose at each time point between T2DM group and HD group(P>0.05).At each time point after taking glucose,the levels of insuline and C-peptide in HD group were significantly higher than those in T2DM group(P<0.05).The levels of insuline at the time of 60,120 and 180 minutes after taking glucose in HD group were significantly higher than those in control group(P<0.05).At the time of 60 minutes after taking glucose,the level of C-peptide in HD group was lower than that in control group(P<0.05),but at the time of 120 and 180 minutes after taking glucose,the levels of C-peptide in HD group were higher than those in control group(P<0.05).The levels of HOMA-β,AUCI30-120/AUCG30-120 and ISI in HD group were higher than those in T2DM group(P<0.05),but the level of FBG/FINS in HD group were lower than that in T2DM group(P<0.05).There was no significant difference in the level of △I30/△G30,HOMA-IR and HIR between HD group and T2DM group(P>0.05).Conclusion IR and hyperinsulinemia exist in patients with HD,mainly early phase insulin secretion injury and postprandial hyperglycemia.