·糖尿病临床研究·

　　以成人酮症起病糖尿病的临床研究

　　吴德云 马维青 汪沪光 吕芳 王国娟 胡国平 司玮

　　【摘要】 目的 探讨成人酮症起病肥胖糖尿病临床特征及其酮症起病可能机制。 方法 选择新诊断糖尿病患者80例，根据入院时BMI、FPG和尿酮体状况分为非酮症组(A组)、非肥胖酮症组(B组)和肥胖酮症组(C组)。入院后均给予胰岛素或胰岛素类似物强化治疗。应用稳态模型评估胰岛素抵抗指数(HOMA-IR)和胰岛β细胞功能(HOMA-β)。随访患者出院后病情转归和用药情况。结果 (1)3组胰岛素强化治疗前的FPG、2 hPG差异均无统计学意义(P>0.05)，C组HbA1c较A组降低(P<0.05)。 C组BMI、TG水平、脂肪肝患病率和HOMA-IR均高于A、B组(P <0.05或P <0.01)，而HDL-C降低(P <0.05), 3组间TC、LDL-C差异无统计学意义(P >0.05)。(2)3组发病时均有IR和胰岛β细胞功能损害，C组IR更加严重。C组强化治疗后，多数患者可停用胰岛素或胰岛素类似物，甚至在一定时间内，单纯生活方式干预即可良好地控制血糖。结论 酮症倾向肥胖糖尿病患者尚保存一定的胰岛β细胞功能。与普通T2DM患者相比，该型糖尿病患者有更严重的IR，脂毒性在病程发展中可能起到更加重要的作用，其临床特征及自然病程更符合T2DM。

　　【关键词】 糖尿病;酮症;肥胖;胰岛素抵抗;糖脂毒性

Clinical research on ketosis-onset diabetic patients in adult WU De-yun, MA Wei-qing, WANG Hu-guang, et al. Department of Endocrinology, First People's Hospital of Anhui Medical University, Hefei 230061, China

　　【Abstract】Objective To investigate the clinical characteristics and possible mechanism in ketosis-onset diabetic patients with obese in adult. Methods A total of 80 inpatients with newly diagnosed diabetes with severe hyperglycemia who had insulin or insulin analogue intensive treatment after being in hospital were divided into three groups: including non-ketosis group (group A), non-obesity ketosis group (group B), and obesity ketosis group (group C) according to body mass index (BMI), fasting plasma glucose (FPG) levels, and qualitative analysis of urine ketone bodies. The homeostasis model assessment of insulin resistance index (HOMA-IR) and insulin β-cell function index (HOMA-β) were used to estimate insulin sensitivity and β-cell function respectively. All patients were followed up by regular visits after discharge. Results (1). Of the three groups, there were no significant difference in FPG and 2 hPG levels before intensive treatment (P>0.05). Compared with group A, the level of HbA1c in group C was significantly lower (P<0.05). Compared with group A and group B, the levels of BMI, triglyceride, HOMA-IR and prevalence of fatty liver in group C were all significantly higher (P <0.05 or P<0.01), meanwhile, the high density lipoprotein cholesterol (HDL-C) level in group C was significantly lower (P<0.05). There was no significant difference in TC and LDL-C levels among the three groups (P>0.05). (2). Insulin resistance damage and β-cell dysfunction were found in all three groups, while the insulin resistance damage of group C was more serious. Most patients in group C could stop insulin or its analogues after intensive treatment and even control blood glucose within a certain period of time by lifestyle intervention. Conclusion The keto-prone diabetic patients with obese have the islet β-cell function to some degree, and they have more serious IR damage in comparing with the common T2DM patients. The lipotoxicity plays a more important role in the development of diabetes, the clinical characteristics and natural course of which are more corresponding to those of diabetes mellitus, type 2.

　　【Keywords】Diabetes mellitus; Ketosis; Obesity; Insulin resistance; Toxicity of glycolipid