胰岛素抵抗及其相关疾病

　　【摘要】 目的 探讨原发性痛风患者不同糖代谢状态胰岛β细胞功能的演变及高胰岛素血症在其中的作用。方法 139例原发性痛风患者分为正常血糖-非高胰岛素血症(NGT-NHIns)A组、正常血糖-高胰岛素血症(NGT-HIns)B组、糖调节受损(IGR)C组、糖尿病(DM)D组。统计及测量相关指标，计算胰岛素抵抗相关指标。结果 (1)A、C、D、B组的HOMA-IR依次升高，ISI依次降低;除B组与D组外，其余各组HOMA-IR、ISI差异均有统计学意义(P<0.05);B组HOMA-IR、△I30/△G30明显高于A组，而ISI明显下降(P<0.05);B组HOMA-β明显高于D组(P<0.05)。(2)总体回归分析：FIns、Ins120、HOMA-β、HOMA-IR、△I30/△G30与糖尿病独立相关，血尿酸水平与糖尿病无关。结论 胰岛素抵抗、胰岛β细胞分泌障碍、胰岛素水平升高是原发性痛风患者发展为糖尿病的主要代谢特征。早期预防糖尿病应该从关注NGT-HIns人群开始。

　　【关键词】原发性痛风胰岛β细胞功能 高胰岛素血症 糖代谢 胰岛素抵抗

　　【Abstract】 Objective To explore the function of islet β cell and hyperinsulinemia in primary gout patients with different status of glucose Metabolism. Methods All the 139 primary gout patients were divided into normal glucose tolerance-non-hyperinsulinemia (NGT-NHIns) A group,normal glucose tolerance-hyperinsulinemia (NGT-HIns) B group,impaired glucose regulation ( IGR ) C group, Diabetes mellitus (DM ) D group. Statistics and measure correlation index,calculate the related index of insulin resisitance .Results (1) With the A 、C、D、B group, the level of HOMA-IR was higher successively, the level of ISI was lower successively. Except for B group and D group, the difference of HOMA-IR、ISI were statistically significant in the other groups(P<0.05). The level of HOMA-IR、△I30/G30 were significantly higher in B group than in the A group, while ISI was significantly lower(P<0.05). The level of HOMA-β was significantly higher in B group than in the D group(P<0.05). (2)The binary logistic regression indicated that FIns、Ins120、HOMA-β、HOMA-IR、△I30/△G30 were independently associated with diabetes, but not with plasma uric acid. Conclusions Insulin resistance、islet β cell dysfunction、increased insulin level were may be the main metabolic features of gout patients with diabetes.Individuals with NGT-HIns should be paid attention to in diabetes prevention study.

　　【Key words】 The primary gout;Islet β cell function;Hyperinsulinemia ;Glucose metabolism;Insulin resistance