摘要
目的：在2型糖尿病家系人群中观察肥胖、胰岛素抵抗、脂代谢紊乱、高血压等因素对2型糖尿病发病的影响。 方法：以1998-06／2000-11在重庆医科大学附属第一医院门诊、住院及参加重庆糖尿病中心健康教育的患者中有家族史的糖尿病患者为先证者，采用统一的家系调查表进行3代成员的调查。①对先证者的父母、同胞、和子代进行标准口服葡萄糖耐量实验，根据糖耐量结果确定2型糖尿病患者281例为糖尿病组，糖耐量减低者85例为糖耐量减低组，葡萄糖耐量正常者131例为未患糖尿病组。纳入对象均对调查及指标检测均知情同意，并积极配合。②按照预先设计的表格对纳入对象进行糖尿病家系调查，表格的主要内容有家系内糖尿病的发病情况、家族史、生活方式，体格检查的各种指标。对所有试验对象询问病史并进行体格检查，测量身高、体质量和血压并绘制家系图谱。③血糖测定采用葡萄糖氧化酶法，三酰甘油、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇的测定采用酶学方法。胰岛素、C肽的测定采用放射免疫法。采用稳态模型评估法评估胰岛素抵抗指数(空腹胰岛素×空腹血糖／22．5)，以体质量指数≥24kg／m^2为肥胖。④计数和计量资料差异比较采用X^2检验和t检验。 结果：有2例或2例以上2型糖尿病患者的家系183个(497人)均进入结果分析。①糖尿病组有高血压史、有冠心病史、高血脂、肥胖人数构成比明显高于未患糖尿病(P＜0．05～0．01)；糖耐量减低组有高血压史、高血脂、肥胖人数构成比明显高于未患糖尿病组(P＜0．05～0．01)。糖尿病组有高血压史、高血脂人数构成比明显高于糖耐量减低组(P＜0．01)。②糖尿病组体质量、收缩压、舒张压、空腹胰岛素、体质量指数、胰岛素抵抗指数明显高于未患糖尿病组(P＜0．05～0．01)，收缩压、舒张压明显低于糖耐量减低组(P＜0．05)，空腹血糖、胰岛素抵抗指数明显高于糖耐量减低组(P＜0．01，0．05)。 结论：①高血压史、冠心病史、高血脂、肥胖、吸烟是2型糖尿病的危险因素。②在糖耐量减低和糖尿病人群中体质量、胰岛素抵抗指数大于未患病人群。③胰岛素抵抗在糖尿病发病前已存在，并随病情发展加重。
AIM： To observe the effects of several risk factors of obesity, insulin resistance, lipid metabolic disorder and hypertension on the attack of type 2 diabetes in a population of familial type 2 diabetes. METHODS： From June 1998 to November 2000, 183 pedigrees, who were the diabetic outpatients and inpatients with diabetic family history in the First Affiliated Hospital, Chongqing University of Medical Sciences, or diabetic patients diabetic family history participated in the health education in Chongqing Diabetes Center, were involved in the study, their family members of 3 generations were investigated with the uniform familial inventory. ① The parents, siblings and children of the pedigrees received the oral glucose tolerance test （OGTT）. According to the results of OGTT, 281 type 2 diabetic patients were taken as the diabetic group, and 85 cases of impaired glucose tolerance （IGT） were taken as IGT group, 131 cases of normal glucose tolerance were taken as the non-diabetic group. All the involved subjects agreed to be investigated and detected, and they all cooperated actively. ② The diabetic families were investigated with the pre-designed list, including familial attack of diabetes mellitus, family history, life style and the indexes of physical examination. The disease history was inquired in all the subjects, they received physical examination, their body height, body mass and blood glucose were measured, and the pedigree atlas was drawn. ③ Blood glucose was detected with the glucose oxidase method, triglyceride, total cholesterol, high density lipoprotein cholesterol （HDL-C）, and low density lipoprotein cholesterol （LDL-C） were determined with the enzymologic method, insulin and C-peptide were detected with radioimmunoassay. Insulin resistance index （IRI, fasting insulinxfasting blood glucose/22.5） was evaluated with Homeostasis model assessment （HOMA）, body mass index ≥ 24 kg/m^2 was taken as obesity. ④ The differences of the enumeration data and measurement data were compared with the x^2 test and t test. RESULTS： All the 183 families （497 cases） containing at least 2 type 2 diabetic patients were involved in the analysis of results. ① The case constituent ratios of the history of hypertension, coronary heart disease, hyperlipidemia and obesity were obviously higher in the diabetic group than in the non-diabetic group （P 〈 0.05-0.01）. The case constituent ratios of the history of hypertension, hyperlipidemia and obesity were markedly higher in the IGT group than in the non-diabetic group （P 〈 0.05-0.01）. The case constituent ratios of the history of hypertension and hyperlipidemia were obviously higher in the diabetic group than in the IGT group （P 〈 0.01）. ② The body mass, systolic pressure, diastolic pressure, fasting insulin, body mass index and IRI in the diabetic group were obviously higher than those in the non-diabetic group （P 〈 0.05-0.01）, systolic pressure and diastolic pressure were remarkably lower than those in the IGT group （P 〈 0.05）, fasting blood glucose and IRI were obviously higher than those in the IGT group （P 〈 0.01, 0.05）. CONCLUSION： ① The history of hypertension and coronary heart disease, hyperlipidemia, obesity and smoking are the risk factors of type 2 diabetic patients. ② The body mass and IRI in IGT and diabetic population are higher than in the non-diabetic population. ③ IGT exists before the attack of diabetes mellitus, and aggravates with the diabetic development.
出处
《中国临床康复》
CSCD
北大核心
2005年第35期12-14,共3页
Chinese Journal of Clinical Rehabilitation
