四川大学华西医院住院初诊早发糖尿病患者的回顾性分析

目的研究早发糖尿病人群的临床特征、代谢状况、胰岛素抵抗以及胰岛β-细胞功能，探讨糖尿病早发的原因。方法回顾性分折638例华西医院住院糖尿病患者中新诊断及病程≤1年，且谷氨酸脱羧酶抗体、胰岛细胞抗体、胰岛素抗体均为阴性者的临床资料，根据诊断时的年龄分为2组。早发糖尿病组（诊断年龄15～45岁）342例，晚发糖尿病组（诊断年龄>45岁）296例。收集所有对象住院病历资料，并用胰岛素抵抗指数（HOMA2-IR）评估胰岛素抵抗，胰岛素敏感指数（HOMA2-%S）评估胰岛素敏感性，胰岛细胞功能指数（HOMA2-%β）评估胰岛细胞分泌功能，餐后30 min胰岛素和空腹胰岛素差值（ΔI30）与餐后30 min血糖和空腹血糖差值（ΔG30）的比值（ΔI30/ΔG30）评估早期胰岛素分泌。比较两组的临床特征、代谢状况、胰岛素抵抗以及胰岛β-细胞功能。结果早发糖尿病组患者以酮症、酮症酸中毒起病的比例、糖尿病家族史阳性率、需要使用胰岛素治疗的比例、空腹及餐后2 h血糖、糖化血红蛋白（HbAlc)、甘油三酯（TG）均高于晚发糖尿病组（P均＜0.01）。早发糖尿病组患者收缩压、舒张压、体质指数（BMI）、腰臀比、尿酸（UA）、空腹及餐后胰岛素和C肽水平低于晚发糖尿病组（P均＜0.01）。早发糖尿病组患者高血压、中心性肥胖、高尿酸、代谢综合征的发生率以及合并3种以上代谢异常的比例低于晚发组（P<0.05，或P<0.01）。早发糖尿病组HOMA2-%β、ΔI30/ΔG30以及HOMA2-IR降低，而HOMA2-%S升高（P<0.01）。多元回归分析显示低HOMA2-%β、低ΔI30/ΔG30以及糖尿病阳性家族史是糖尿病早发的独立预测因素。结论早发糖尿病患者代谢异常的发生率低，代谢综合征、胰岛素抵抗以及胰岛素敏感性降低并不是影响糖尿病早发的因素，胰岛β细胞功能障碍可能是其影响因素。

英文摘要:

Objective To investigate the clinical characteristics, metabolic status, insulin resistance and insulin secretory function of diabetic patients with early onset. Methods The study was undertaken in the West China Hospital of Sichuan University. Characteristics of 342 admitted diabetic patients with early onset (EOD group, diagnosed at age 15-45 years old) were reviewed and compared with 296 admitted patients with late onset (LOD group, diagnosed at age＞45 years old). All of the participants had negative islet autoantibodies. Homeostasis model assessment 2 of insulin resistant (HOMA2-IR) and HOMA2 of insulin sencitivity (HOMA2-%S) were measured to estimate insulin resistance and insulin sensitivity. HOMA2 of β-cell function (HOMA2-%β) index was used to estimate β-cell secretory function. We also compared clinical characteristics and metabolic status between the two groups. Results EOD patients were more likely to have ketosis,ketoacidosis, insulin therapy and positive diabetic family history than LOD patients (P<0.05). Levels of systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI), waist-to-hip ratio (WHR), fasting and postprandial insulin (FIns, PIns), fasting and postprandial plasma C-peptide (FCP, PCP) were significantly lower, and glycosylated hemoglobin A1c (HbA1c), triglycerides (TG), fasting and postprandial blood glucose (FPG, PPG) were significantly higher in EOD patients than in LOD patients (P<0.05). EOD patients had lower prevalence of hypertension, central obesity, hyperuricemia, metabolic syndrome (MS) and co-exist of three or more metabolic disorders than LOD patients (P<0.05). EOD patients had decreased levels of HOMA2-%β, ΔI30/ΔG30 and HOMA2-IR, increased HOMA2-%S, and increased proportions with FCP<0.2 nmol/L and FIns＜2.9 μU/mL [CM(155.3mm]compared with LOD patient (P<0.05). Linear regression analyses showed that HOMA2-%β, ΔI30/ΔG30, positive diabetic family history were independent risk factors predicting early onset of diabetes. Conclusion Early onset diabetic patients are characterized with low prevalence of metabolic disorders, insulin resistance and severe insulin secretion dysfunction. Loss of β-cell function may play a major role in the development of early onset diabetes in this population.

查看全文查看/发表评论下载PDF阅读器

关闭