肥胖对胰岛功能及胰岛素作用的影响

摘要

目的 探讨肥胖对胰岛功能及胰岛素作用的影响.方法 选择2010年3月在我院体检的某单位人群331例,按体重指数(BMI)分为体重正常组(122例),BMI 18.5-23.9 kg/m2、超重组(166例),BMI 24.0-27.9 kg/m2和肥胖组(43例),BMI≥28 kg/m).均行口服葡萄糖耐量试验(OGTT)及胰岛素、C肽释放试验,计算胰岛素敏感指数(IAI)、胰岛素抵抗指数(IR)、胰岛素分泌指数( HBCI)和空腹β细胞功能指数(FBCI),比较3组之间胰岛功能及胰岛素作用的变化.结果 超重组与肥胖组BMI、腰围、餐后2-h血糖(2-h PBG)、空腹胰岛素(FINS)、口服糖水后60 min胰岛素(INS60)、胰岛素稳态模型-胰岛素抵抗指数(HOMA-IR)、胰岛素稳态模型-β细胞分泌功能(HOMA-β)、FBCI水平增高,高密度脂蛋白(HDL)降低,与正常体重组比较,差异有统计学意义(P＜0.05).肥胖组TG较超重组、体重正常组升高(P＜0.05).其他代谢指标如空腹血糖(FBG)、糖化血红蛋白(HbA1c)、低密度脂蛋白(LDL)、收缩压(SBP)及舒张压(DBP)3组间差异无统计学意义.结论 肥胖为糖尿病的高危因素.肥胖者伴随着胰岛素抵抗及敏感性进行性下降,胰岛分泌功能呈代偿性增高趋势.%Objective To investigate the effects of obesity on pancreatic β cell function and insulin function. Methods A total of 331 cases who took the medical examination in March 2010 in our hospital was categorized into three groups of A( 122 cases with normal BMI of 18. 5-23. 9 kg/m2), B(166 cases with BMI of 24. 0-27. 9 kg/m2) and C(43 cases with BMI≥28 kg/m2). Everyone took oral glucose tolerance test(OGTT) and release tests of insulin and C-peptide. The insulin sensitivity index(IAD, insulin resistance index(IR), insulin secretion index(HBCI) and fasting β cell function index(FBCI) were calculated and compared. Results Compared with group A, BMI, waist circumference,and 2-h blood sugar after meal ( 2-hPBG), FINS, INS60, homa-ir, HOMA-β, FBCI in groups of B and C were higher, but high-density lipoprotein ( HDL) was significantly lower (P<0. 05). Serum triglyceride (TG) was significantly higher in group C than that in groups of A and B(P<0. 05). The differences in fasting blood sugar(FBG) ,glycated hemoglobin( HbAlc), low density lipoprotein(LDL), blood pressure(BP) were not significantly different among three groups. Conclusion Obesity is one of the risk factors for diabetes. The insulin secretion of obese people showes a trend of compensatory increase as insulin sensitivity decreases and insulin resistance increases.