成都地区2型糖尿病患者糖耐量正常一级亲属代谢紊乱的临床研究

【】　目的　调查成都地区2型糖尿病患者糖耐量正常一级亲属的代谢状态及与胰岛素抵抗、胰岛β细胞功能的相关性。　方法　2007年7-9月共纳入糖耐量正常的一级亲属312例（NGT-FDR组），无家族史的正常对照1348例（NGT-C组）。测量两组血压、体重、腰围；检测口服葡萄糖耐量试验（OGTT）中0、0.5、2h血糖、胰岛素水平；测定空腹血脂；计算体重指数、HOMA-胰岛素抵抗指数（HOMA-IR）、胰岛β细胞功能指数（HOMA-β），β细胞早相分泌功能指数（△I30/△G30），并比较两组间上述指标的差异和代谢综合征（MS）及其各组分的发病情况。　结果　①NGT-FDR组MS发生率高于NGT-C组，发生MS的风险是后者的1.737倍。NGT-FDR组高甘油三酯血症（hypertriglyceridemia，HTG）、空腹血糖偏高（5.6~6.0mmol/L）的发生率高于NGT-C组，合并4种及以上代谢异常的几率亦高于NGT-C组（P<0.05）；②年龄<40岁的NGT-FDR中心性肥胖、HTG、空腹血糖偏高和MS均高于同年龄对照；男性NGT-FDR空腹血糖偏高和MS发病率高于男性对照（P<0.05）；③腰围、收缩压（SBP）、空腹血糖（FBG）、甘油三酯（TG）及糖尿病家族史同HOMA-IR呈正相关。腰围、SBP、TG及糖尿病家族史同HOMA-β呈正相关，FBG则同HOMA-β呈负相关。　结论　2型糖尿病糖耐量正常一级亲属比无家族史的对照表现出更多的代谢异常，尤其是在年龄<40岁及男性中。各种代谢异常可加重胰岛素抵抗，影响胰岛基础分泌功能。故有必要对糖耐量正常的一级亲属进行各项代谢指标的监测和早期预防性干预。？【Abstract】　Objective　Toinvestigatethemetabolicstatusofthenormalglucose-tolerantfirst-degreerelatives(NGT-FDR)oftype-2diabeticpatientsanditsrelationshipwithinsulinresistance(IR)andβ-cellfunctioninChengduarea.　Methods　FromJulytoSeptember2007,atotalof312NGT-FDRoftype-2diabeticpatientsand1348normalglucosetolerantcontrolswithoutpositivefamilyhistoryofdiabetes(NGT-C)wereenrolledinthisstudy.Bloodpressure,weight,waists,plasmaglucoseathour0,1/2and2inoralglucosetolerancetest(OGTT),insulinlevelsandfastingbloodlipidsweremeasured.Bodymassindex(BMI),HOMA-IR,HOMA-βandtheearlyinsulinsecretingindex(△I30/△G30)werecalculated.Then,wecomparedtheabove-mentioneddataandtheincidenceofmetabolicsyndrome(MS)betweenthetwogroups.　Results　①TheincidenceofMS,hypertriglyceridemia(HTG),higherfastingbloodglucose(FBG)(5.6-6.0mmol/L)intheNGT-FDRgroupwereallsignificantlyhigherthanthoseintheNGT-Cgroup.TheriskofdevelopingMSintheNGT-FDRgroupwas1.737timesashighasthatintheNGT-Cgroup.Furthermore,theincidenceof4ormorethan4co-existentmetabolicdisordersintheNGT-FDRgroupwasalsosignificantlyhigherthanthatintheNGT-Cgroup(P<0.05);②Forsubjectslessthan40yearsold,theincidenceofcentralobesity,HTG,higherFBGandMSintheNGT-FDRgroupwereallhigherthanthoseintheNGT-Cgroup.Inmalesubjects,theratesofhigherFBGandMSwereallsignificantlyhigherintheNGT-FDRgroupthanthoseintheNGT-Cgroup.(P<0.05);③Waists,FBG,systolicbloodpressure(SBP),triglycerides(TG)anddiabeticfamilyhistorywerepositivelycorrelatedwithHOMA-IR.Waists,SBP,TGanddiabeticfamilyhistorywerepositivelycorrelatedwithHOMA-β.　Conclusion　NGT-FDRpresentsignificantlyincreasedmetabolicdisordersthanNGTcontrols,especiallyinthelessthan40-year-oldandthemalesubjects.Themetabolicdisorderscanaggravateinsulinresistanceandinfluenceisletβ-cellsecretionfunction,soitisnecessarytomonitorthemetabolicstatusoftheNGT-FDRoftype-2diabeticpatientsandprovideearlypreventiveinterventions.