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

doi:10.3969/j.issn.1006-7795.2016.03.027

首都医科大学学报 ›› 2016, Vol. 37 ›› Issue (3): 385-390.doi: 10.3969/j.issn.1006-7795.2016.03.027

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

康怡, 张宝和, 徐洪涛, 田光, 姚合斌, 赵宏, 黄火高, 连世杰, 杜凯音, 华伟, 胡晓东, 王吉

海军总医院内分泌科, 北京 100048

收稿日期:2016-03-01 出版日期:2016-06-21 发布日期:2016-06-13
通讯作者: 张宝和 E-mail:zbh129778@sina.com
基金资助:
海军后勤科研项目(CHJ12L024)。

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

Kang Yi, Zhang Baohe, Xu Hongtao, Tian Guang, Yao Hebin, Zhao Hong, Huang Huogao, Lian Shijie, Du Kai-yin, Hua Wei, Hu Xiaodong, Wang Ji

Department of Endocrinology, Navy General Hospital, Beijing 100048, China

Received:2016-03-01 Online:2016-06-21 Published:2016-06-13
Supported by:
This study was supported by Navy Logistics Research (CHJ12L024).

摘要/Abstract

摘要： 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。

关键词: 糖调节受损, 高胰岛素血症, 胰岛素抵抗, 胰岛功能

Abstract: 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.

Key words: impaired glucose regulation, hyperinsulinemia, insulin resistance, pancreatic islet function

中图分类号:

R587

康怡, 张宝和, 徐洪涛, 田光, 姚合斌, 赵宏, 黄火高, 连世杰, 杜凯音, 华伟, 胡晓东, 王吉. 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[J]. 首都医科大学学报, 2016, 37(3): 385-390.

Kang Yi, Zhang Baohe, Xu Hongtao, Tian Guang, Yao Hebin, Zhao Hong, Huang Huogao, Lian Shijie, Du Kai-yin, Hua Wei, Hu Xiaodong, Wang Ji. Evaluation of metabolic disorders and pancreatic islet function in aged male patients with hyperinsulinemia in Beijing[J]. Journal of Capital Medical University, 2016, 37(3): 385-390.

参考文献

[1] Kahn C R. Insulin resistance, insulin insensitivity and insulin unresponsiveness: a necessary distinction[J]. Metabolism,1978,27(12 Suppl 2):1893-1902.
[2] Reusch J E. Current concepts in insulin resistance, type 2 diabetes mellitus, and the metabolic syndrome[J]. Am J Cardiol,2002,90(5A):19G-26G.
[3] Cobelli C, Toffolo G M, Dalla Man C,et al. Assessment of beta-cell function in humans, simultaneously with insulin sensitivity and hepatic extraction, from intravenous and oral glucose tests[J]. Am J Physiol Endocrinol Metab, 2007, 293(1):E1-E15.
[4] Larsson H, Ahren B. Glucose-dependent arginine stimulation test for characterization of islet function: studies on reproducibility and priming effect of arginine[J]. Diabetologia, 1998, 41(7):772-777.
[5] Kahn C R, Weir G C, King G L, et al. Joslin's diabetes mellitus[M]. 14th ed. Boston: Lippincott Williams Wilkins, 2007.
[6] 康怡, 陆菊明, 孙敬芳,等.不同糖调节受损人群的血糖波动特征[J]. 中华医学杂志,2009,89(10):669-672
[7] Ramasarma T, Rafi M. A glucose-centric perspective of hyperglycemia[J]. Indian J Exp Biol,2016,54(2):83-99.
[8] Lauro D, Kido Y, Castle A L, et al. Impaired glucose tolerance in mice with a targeted impairment of insulin action in muscle and adipose tissue[J]. Nat Genet,1998,20(3):294-298.
[9] Fisher S J, Kahn C R. Insulin signaling is required for insulin's direct and indirect action on hepatic glucose production[J]. J Clin Invest, 2003,111(4):463-468.
[10] 杨宁,王立,徐援,等.胰岛素抵抗与凝血指标和血小板参数的相关性分析[J].首都医科大学学报,2013,34(1):144-149.
[11] 吕肖锋,黄金鑫,张微微,等. 急性脑梗死合并2型糖尿病与血糖漂移及同型半胱氨酸水平的相关性研究[J]. 解放军医药杂志,2013,25(11):16-20.
[12] 陆菊明,卢艳慧.糖尿病前期人群的胰岛素分泌功能和血管病变[J].国际内分泌代谢杂志,2006,26(3):213-214.

[1]	王景尚, 尹晓丹, 何军琴, 武颖, 张莹, 李宪锐. 来曲唑联合高糖高脂饮食构建多囊卵巢综合征伴胰岛素抵抗大鼠模型研究[J]. 首都医科大学学报, 2021, 42(3): 436-442.
[2]	金婧, 阮祥燕, 华琳, 李杨璐, 王利娟, 王虎生, 赵越, Alfred O. Mueck. 多囊卵巢综合征卵巢储备功能降低患者肥胖及糖脂代谢特征[J]. 首都医科大学学报, 2018, 39(4): 505-511.
[3]	鹿星梦, 信中. Ang(1-7)通过调节内质网应激改善骨骼肌脂代谢及胰岛素抵抗[J]. 首都医科大学学报, 2018, 39(4): 532-536.
[4]	金贺, 赵志炜, 王蓉. 追赶生长与阿尔茨海默病相关性[J]. 首都医科大学学报, 2017, 38(6): 831-834.
[5]	殷冬梅, 阮祥燕, 赵越, Alfred O. Mueck. 北京地区多囊卵巢综合征病人内分泌代谢特征分析[J]. 首都医科大学学报, 2017, 38(4): 498-503.
[6]	卢晶, 沈涵, 程呈, 宋丽妮, 张怡尘, 谢荣荣, 袁明霞, 杨金奎. hERG钾通道通过降低氧化应激改善肝细胞糖代谢[J]. 首都医科大学学报, 2017, 38(2): 156-160.
[7]	蔡云, 许昕. 来曲唑联合高脂饲料建立PCOS-IR大鼠模型实验研究[J]. 首都医科大学学报, 2017, 38(2): 244-248.
[8]	李扬璐, 阮祥燕, Alfred O. Mueck. 多囊卵巢综合征对妊娠结局的影响研究进展[J]. 首都医科大学学报, 2016, 37(4): 449-453.
[9]	赵越, 阮祥燕, 崔亚美, 李扬璐, 武红琴, 杜娟, 张颖, 田玄玄, Diethelm Wallwiener, Alfred O. Meuck. 不同亚型的多囊卵巢综合征患者临床及实验室指标特征的研究[J]. 首都医科大学学报, 2015, 36(4): 567-572.
[10]	曹曦, 杨芳远, 史婷婷, 谢荣荣, 信中, 杨金奎. ACE2/Ang-(1-7)改善肝细胞糖代谢[J]. 首都医科大学学报, 2014, 35(6): 755-759.
[11]	马亚红, 阿布杜拉·热西提, 谢北辰, 郭鑫, 杨金奎, 刘国庆. 严重高三酰甘油血症对小鼠生育及其后代糖脂代谢的影响[J]. 首都医科大学学报, 2014, 35(1): 51-55.
[12]	赵向府, 庄晓明. 脂肪营养不良综合征[J]. 首都医科大学学报, 2013, 34(2): 315-323.
[13]	杨宁, 王立, 徐援, 张冬磊. 胰岛素抵抗与凝血指标和血小板参数的相关性分析[J]. 首都医科大学学报, 2013, 34(1): 144-149.
[14]	胡虹英;刘颖;杨金奎. 2型糖尿病合并乙型肝炎病毒携带患者的临床分析[J]. 首都医科大学学报, 2011, 32(5): 602-604.
[15]	洪忠新;华鑫. 两种处方饮食对2型糖尿病患者血糖及胰岛素抵抗的影响[J]. 首都医科大学学报, 2011, 32(1): 142-145.

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

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

PDF

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价