年龄和家族史对中国成年人胰岛素分泌和胰岛素作用的影响
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摘要
第一部分：NGT人群胰岛功能及胰岛素敏感性随增龄的变化
目的探讨中国正常糖耐量人群胰岛功能及胰岛素敏感性随增龄的变化。
方法以2007-08年全国糖尿病及代谢综合征患病率变迁调查中的34239例正常糖耐量者(NGT)为研究对象,采用标准问卷,获取有关人口统计学特征、个人和家庭医疗史以及生活方式危险因素的资料。采用标准方法测量血压、体重、身高和腰围。对每位受试者禁食10小时后行75g口服葡萄糖耐量试验,测量血糖、胰岛素、血脂等生化指标水平。按照1999年WHO诊断标准确定正常糖耐量人群,并计算出反映胰岛素分泌(Homa-B、△130/AG30、InsAuc30/GluAuc30、 InsAuc120/GluAuc120)、胰岛素敏感性(Homa-IR、Matsuda指数)、胰岛功能(处置指数Homa-B/Homa-IR、DI30、DI120)的指标。
结果
1)单因素线性回归结果发现在总体人群和男性中反映胰岛素分泌指标(Homa-B、△I30/AG30、InsAuc30/GluAuc30)及Homa-IR均与年龄呈负相关关系、Matsuda指数与年龄呈正相关关系；女性中反映胰岛素抵抗及敏感性的指标和年龄无相关关系。
2)在回归方程中纳入BMI和腰围进行多因素线性回归结果发现：校正了肥胖相关指标的影响后,总体人群和男性中的相关结果仍然有统计意义,但在女性当中,Homa-B与年龄无相关关系,而Matsuda指数与年龄呈正相关关系, Homa-IR与年龄呈负相关关系。
3)处置指数中Homa-B/Homa-IR无论校正BMI和腰围与否均与年龄无线性相关,而D130、DI120无论校正BMI和腰围与否均与年龄呈负相关。
结论在中国NGT人群中,基础胰岛素分泌量随增龄降低,在校正胰岛素敏感性后基础胰岛功能与年龄不存在有统计学意义的线性关系；口服葡萄糖负荷后早相及全时相的胰岛索分泌和胰岛功能均随增龄而下降;胰岛素敏感性并未随着增龄而导致的体重及体脂分布变化而减弱。
第二部分：不同年龄段新诊断糖尿病患者特征差异分析
目的探讨青年、中年及老年T2DM患者临床特征,进一步认识不同年龄段T2DM的发病特点和发病机制,以便有针对性的进行预防和治疗。
方法以2007-08年全国糖尿病及代谢综合征患病率变迁调查中发现新诊断糖尿病患者2908人为研究对象,将其按照年龄分为20-39岁组(青年组)、40-59岁组(中年组)、60岁以上组(老年组)。调查及检验指标同第一部分。
结果
1)在所有初诊DM患者中超重及肥胖比例达50%-60%,中心性肥胖的比例达到50%左右；不同年龄段初诊DM患者的FPG、UA、Cr水平、BMI、心率平均值无显著差异；
2)随着年龄增加,SBP水平升高、进行规律运动比例升高、小学及以下文化程度的比例升高,而DM家族史阳性的比例降低,饮酒的比例也降低；
3)青年组的负荷后血糖(PG-2h)、TC、LDL-c和HDL-c水平均低于中年祖和老年组；中年组的平均腰围大于青年组、超重者比例高于老年组,并有着最高的平均DBP水平；老年组有着较低的TG和较高的尿蛋白/肌酐(U-alb/cr)。
4)不同年龄段初诊糖尿病患者胰岛功能有以下特点：F-ins、2h-ins、Homa-B、 Homa-IR及Matsuda指数、DI120均无显著差异,而中年组和老年组的△I30/△G30与青年组相比显著降低、老年组的DI30显著低于中年组和青年组。
结论在青年组中有较高的DM家族史比例和TG水平,较高的饮酒比例和较低的规律运动比例；在中年组中较大的平均腰围及超重者比例、最高的平均DBP水平；住老年组中有着较高的TC、LDL-c及尿蛋白/肌酐,最差的早相胰岛素分泌。而其他反映胰岛功能和胰岛素抵抗的指标没有统计学意义的区别。在对青年人的防治中应加强家族史阳性者的筛查,同时注意生活方式的改善;对中年人防整中除了加强生活方式的改善外应减少精神紧张等激活交感神纤的应激因素；老年人防治中应加强对早相胰岛分泌的保护和恢复,并应加强对血压血脂等综合达标控制。
第三部分：DM家族史对初诊糖尿病患者胰岛功能及胰岛素敏感性的影响
目的探讨DM家族史对初诊糖尿病患者胰岛功能及胰岛素敏感性的影响。
方法以2007-08年全国糖尿病及代谢综合征患病率变迁调查中发现新诊断糖尿病患者2908人为研究对象,按照一级亲属中有无糖尿病患者分为DMFH(+)组和DMFH(.)组。采用标准问卷,获取有关人口统计学特征、个人和家庭医疗史以及生活方式危险因素的资料。调查及检验指标同第一部分。
结果
1)两组中性别构成及平均年龄均无差别,DMFH(+)组有着较高的FPG及PG2h、BMI、TG、DMFH(+)组中参加规律运动比例、饮酒的比例高于DMFH(-)组,而小学及以下文化程度的比例要低于DMFH(-)组。
2)DMFH(+)组的F-ins水平高于DMFH(-)组,反映肝脏胰岛素抵抗的Homa-IR高于DMFH(-),反映全身胰岛素敏感性的Matsuda指数低于DMFH(-),而反映胰岛素分泌量的Homa-B、△130/△G30、InsAuc30/GluAuc30及InsAuc120/GluAuc120在两组间均无差异,反映校正胰岛素抵抗后的胰岛代偿功能的指标处置指数△130/△G30/homa-IR、D130、DI120在DMFH(+)组要低于DMFH(-)组。
3)线性回归分析发现DMFH(+)与Homa-IR正相关,与Matsuda指数负相关；在分别校正了DM家族史、BMI、腰围、TG及以上因素的组合后,DMFH(+)仍与Matsuda指数负相关,表明DMFH(+)导致全身胰岛素敏感性减低存在者不依赖于BMI、腰围、TG的其他机制。DMFH(+)与Homa-IR之间的正相关关系在回归方程中引入BMI后均消失,说明DMFH(+)导致的Homa-IR可能与BMI升高有关。
结论在我国初诊糖尿病患者中,无论有无DM家族史,平均胰岛素分泌的指标并无差别,而胰岛素敏感性在DMFH(+)组中明显下降；DMFH(+)导致全身胰岛素敏感性减低存在着不依赖于BMI、腰围、TG的其他机制。DMFH(+)导致的Homa-IR可能与BMI升高有关。提示我们在临床工作中要针对不同DM家族史者采取有针对性防治策略,在家族史阳性的患者中要特别注意减体重并改善胰岛素敏感性。
第四部分：年龄和和DM家族史在男性DM患病中的交互作用
目的探讨阳性糖尿病家族史男性中患病率随增龄直线增长的可能原因
方法以2007-08年全国糖尿病及代谢综合征患病率变迁调查中的男性共18419人为研究对象,按照一级亲属中有无糖尿病患者分为DMFH(+)组和DMFH(-)组。调擦汗及检验指标同第一部分。
结果
1)DMFH(+)组FPG、PG-2h、BMI、腰围、心率、SBP、DBP、TC、TG、 LDL-C、超重人群比例、中心性肥胖比例、饮酒比例、规律运动比例均高于DMFH(-)组。
2)DMFH(+)和DMFH(-)组患病率随增龄的曲线形态不同：在DMFH(+)组中,患病率随增龄旱直线增长,平均每增加10岁患病率增加10%左右；而在DMFH(-)2(?)中在20-60岁之间增长较快,而在60岁以后增长较缓慢,60-69岁及70岁以上组患病率类似(16.3%vs16.8%)。
3)HOMA-B、△130/△G30、D130、D1120在不同家族史组中随增龄的变化趋势相同,均随着年龄增长而逐渐下降;
4)反映胰岛素抵抗及敏感性的指标(HOMA-IR、Matsuda Index)在不同DM家族史男性中随增龄的变化情况有差异：在DMFH(-)组中HOMA-IR及Matsuda Indcx随着增龄无显著的变化趋势,而在DMFH(+)组中反映肝脏胰岛素抵抗的HOMA-IR随着增龄而升高,反映全身胰岛素敏感性的Matsuda Index随着增龄而降低,结果均有统计学意义。
5)DMFH(+)组与DMFH(-)组在各个年龄段中反映胰岛素分泌的指标(HOMA-B(除外60-69岁纤)、△130/△G30(除外50-59岁组))无差别。
6)在40岁以上各个年龄组的男性中,反映胰岛功能的指标(D130、D1120)在DMFH(-)(?)均高于DMFH(+)组,结果有统计学意义
7)在各个年龄段中反映全身胰岛素敏感性的指标Matsuda指数在DMFH(-)组均高于DMFH(+)组,结果仃统计学意义。在30岁以上各个年龄组的男性中,反映肝脏胰岛素抵抗的指标(HOMA-IR)DMFH(-)组均低于DMFH(+)组,结果有统计学意义。
结论DM家族史的影响并非一成不变,而与增龄及其相关的环境因素存在交互作用,这种影响主要体现在胰岛素作用上,在男性各个年龄组DMFH(+)组胰岛素敏感性均低于DMFH(-)组；在DMFH(-)组中HOMA-IR及Matsuda Index随着增龄无显著的变化趋势,而在DMFH(+)组中反映肝脏胰岛素抵抗的HOMA-IR随着增龄而升高,反映全身胰岛素敏感性的Matsuda Index随着增龄而降低。
Part1. Ageing related changes of insulin secretion and insulin sensitivity among normal glucose tolerance individuals in China
Objective: To investigate ageing related changes of insulin secretion and insulin sensitivity among normal glucose tolerance (NGT) individuals in China.
Methods:34239individuals were included in the analysis, all of which were described as NGT by75g oral glucose tolerance test (75gOGTT) according to the diagnosis criterion of WH01999. Homa-B, AI30/AG30,IiisAuc30/GIuAuc30,1nsAiic120/G1uAuc120were calculated to estimate insulin secretion; Honia-IR and Matsuda index were calculated to estimate insulin sensitivity; Dispositon index: Homa-B/Hoina-IR,D130and D1120were calculated to estimate13-cell function.
Results: In univariate linear regression, Homa-B, AI30/AG30InsAuc30/GluAuc30and Homa-IR were negatively correlated with age, Matsuda Index was positively correlated with age among men and overall, while no correlation was found between Horna-IR/Matsuda Index and ageing among women. In mutilivariate linear regression, the results among men and overall still existed after adjusted for BMI and waist circumference; while there was no correlation between Homa-B and ageing among women, Matsuda Index was positively correlated with age and Homa-IR were negatively correlated with age among women after adjusted for BMI and waist circumference. No linear correlation was found between Homa-B/I loina-lR and agcing, D130and D1120were negatively correlated with age in both uni',-0Mriate < Conclusions: The basal insulin secretion amount is lower in elder groups among NGT individuals in China, but this relation disappears after adjusted for insulin resistance. The early phase and total insulin secretion postchallenge decreases with ageing even after adjusted for insulin resistance. Hepatic and overall insulin sensitivity does not deteriorate with ageing and its related change of body composition and weight gain.
Part2. Characteristics of type2diabetes mellitus in the newly diagnosed patients of different age groups
Objective:To investigate the clinical metabolic characteristics of type2diabetes mellitus (T2DM) in newly diagnosed patients of different age groups.
Methods:2908individuals with no previous medical history of diabetes mellitus were included in the analysis, all of which were described as T2DM by75g oral glucose tolerance test (75gOGTT) according to the diagnosis criterion of WHO1999. These newly diagnosed DM patients were divided into three age groups:youth (
目的探讨中国正常糖耐量人群胰岛功能及胰岛素敏感性随增龄的变化。
方法以2007-08年全国糖尿病及代谢综合征患病率变迁调查中的34239例正常糖耐量者(NGT)为研究对象,采用标准问卷,获取有关人口统计学特征、个人和家庭医疗史以及生活方式危险因素的资料。采用标准方法测量血压、体重、身高和腰围。对每位受试者禁食10小时后行75g口服葡萄糖耐量试验,测量血糖、胰岛素、血脂等生化指标水平。按照1999年WHO诊断标准确定正常糖耐量人群,并计算出反映胰岛素分泌(Homa-B、△130/AG30、InsAuc30/GluAuc30、 InsAuc120/GluAuc120)、胰岛素敏感性(Homa-IR、Matsuda指数)、胰岛功能(处置指数Homa-B/Homa-IR、DI30、DI120)的指标。
结果
1)单因素线性回归结果发现在总体人群和男性中反映胰岛素分泌指标(Homa-B、△I30/AG30、InsAuc30/GluAuc30)及Homa-IR均与年龄呈负相关关系、Matsuda指数与年龄呈正相关关系；女性中反映胰岛素抵抗及敏感性的指标和年龄无相关关系。
2)在回归方程中纳入BMI和腰围进行多因素线性回归结果发现：校正了肥胖相关指标的影响后,总体人群和男性中的相关结果仍然有统计意义,但在女性当中,Homa-B与年龄无相关关系,而Matsuda指数与年龄呈正相关关系, Homa-IR与年龄呈负相关关系。
3)处置指数中Homa-B/Homa-IR无论校正BMI和腰围与否均与年龄无线性相关,而D130、DI120无论校正BMI和腰围与否均与年龄呈负相关。
结论在中国NGT人群中,基础胰岛素分泌量随增龄降低,在校正胰岛素敏感性后基础胰岛功能与年龄不存在有统计学意义的线性关系；口服葡萄糖负荷后早相及全时相的胰岛索分泌和胰岛功能均随增龄而下降;胰岛素敏感性并未随着增龄而导致的体重及体脂分布变化而减弱。
第二部分：不同年龄段新诊断糖尿病患者特征差异分析
目的探讨青年、中年及老年T2DM患者临床特征,进一步认识不同年龄段T2DM的发病特点和发病机制,以便有针对性的进行预防和治疗。
方法以2007-08年全国糖尿病及代谢综合征患病率变迁调查中发现新诊断糖尿病患者2908人为研究对象,将其按照年龄分为20-39岁组(青年组)、40-59岁组(中年组)、60岁以上组(老年组)。调查及检验指标同第一部分。
结果
1)在所有初诊DM患者中超重及肥胖比例达50%-60%,中心性肥胖的比例达到50%左右；不同年龄段初诊DM患者的FPG、UA、Cr水平、BMI、心率平均值无显著差异；
2)随着年龄增加,SBP水平升高、进行规律运动比例升高、小学及以下文化程度的比例升高,而DM家族史阳性的比例降低,饮酒的比例也降低；
3)青年组的负荷后血糖(PG-2h)、TC、LDL-c和HDL-c水平均低于中年祖和老年组；中年组的平均腰围大于青年组、超重者比例高于老年组,并有着最高的平均DBP水平；老年组有着较低的TG和较高的尿蛋白/肌酐(U-alb/cr)。
4)不同年龄段初诊糖尿病患者胰岛功能有以下特点：F-ins、2h-ins、Homa-B、 Homa-IR及Matsuda指数、DI120均无显著差异,而中年组和老年组的△I30/△G30与青年组相比显著降低、老年组的DI30显著低于中年组和青年组。
结论在青年组中有较高的DM家族史比例和TG水平,较高的饮酒比例和较低的规律运动比例；在中年组中较大的平均腰围及超重者比例、最高的平均DBP水平；住老年组中有着较高的TC、LDL-c及尿蛋白/肌酐,最差的早相胰岛素分泌。而其他反映胰岛功能和胰岛素抵抗的指标没有统计学意义的区别。在对青年人的防治中应加强家族史阳性者的筛查,同时注意生活方式的改善;对中年人防整中除了加强生活方式的改善外应减少精神紧张等激活交感神纤的应激因素；老年人防治中应加强对早相胰岛分泌的保护和恢复,并应加强对血压血脂等综合达标控制。
第三部分：DM家族史对初诊糖尿病患者胰岛功能及胰岛素敏感性的影响
目的探讨DM家族史对初诊糖尿病患者胰岛功能及胰岛素敏感性的影响。
方法以2007-08年全国糖尿病及代谢综合征患病率变迁调查中发现新诊断糖尿病患者2908人为研究对象,按照一级亲属中有无糖尿病患者分为DMFH(+)组和DMFH(.)组。采用标准问卷,获取有关人口统计学特征、个人和家庭医疗史以及生活方式危险因素的资料。调查及检验指标同第一部分。
结果
1)两组中性别构成及平均年龄均无差别,DMFH(+)组有着较高的FPG及PG2h、BMI、TG、DMFH(+)组中参加规律运动比例、饮酒的比例高于DMFH(-)组,而小学及以下文化程度的比例要低于DMFH(-)组。
2)DMFH(+)组的F-ins水平高于DMFH(-)组,反映肝脏胰岛素抵抗的Homa-IR高于DMFH(-),反映全身胰岛素敏感性的Matsuda指数低于DMFH(-),而反映胰岛素分泌量的Homa-B、△130/△G30、InsAuc30/GluAuc30及InsAuc120/GluAuc120在两组间均无差异,反映校正胰岛素抵抗后的胰岛代偿功能的指标处置指数△130/△G30/homa-IR、D130、DI120在DMFH(+)组要低于DMFH(-)组。
3)线性回归分析发现DMFH(+)与Homa-IR正相关,与Matsuda指数负相关；在分别校正了DM家族史、BMI、腰围、TG及以上因素的组合后,DMFH(+)仍与Matsuda指数负相关,表明DMFH(+)导致全身胰岛素敏感性减低存在者不依赖于BMI、腰围、TG的其他机制。DMFH(+)与Homa-IR之间的正相关关系在回归方程中引入BMI后均消失,说明DMFH(+)导致的Homa-IR可能与BMI升高有关。
结论在我国初诊糖尿病患者中,无论有无DM家族史,平均胰岛素分泌的指标并无差别,而胰岛素敏感性在DMFH(+)组中明显下降；DMFH(+)导致全身胰岛素敏感性减低存在着不依赖于BMI、腰围、TG的其他机制。DMFH(+)导致的Homa-IR可能与BMI升高有关。提示我们在临床工作中要针对不同DM家族史者采取有针对性防治策略,在家族史阳性的患者中要特别注意减体重并改善胰岛素敏感性。
第四部分：年龄和和DM家族史在男性DM患病中的交互作用
目的探讨阳性糖尿病家族史男性中患病率随增龄直线增长的可能原因
方法以2007-08年全国糖尿病及代谢综合征患病率变迁调查中的男性共18419人为研究对象,按照一级亲属中有无糖尿病患者分为DMFH(+)组和DMFH(-)组。调擦汗及检验指标同第一部分。
结果
1)DMFH(+)组FPG、PG-2h、BMI、腰围、心率、SBP、DBP、TC、TG、 LDL-C、超重人群比例、中心性肥胖比例、饮酒比例、规律运动比例均高于DMFH(-)组。
2)DMFH(+)和DMFH(-)组患病率随增龄的曲线形态不同：在DMFH(+)组中,患病率随增龄旱直线增长,平均每增加10岁患病率增加10%左右；而在DMFH(-)2(?)中在20-60岁之间增长较快,而在60岁以后增长较缓慢,60-69岁及70岁以上组患病率类似(16.3%vs16.8%)。
3)HOMA-B、△130/△G30、D130、D1120在不同家族史组中随增龄的变化趋势相同,均随着年龄增长而逐渐下降;
4)反映胰岛素抵抗及敏感性的指标(HOMA-IR、Matsuda Index)在不同DM家族史男性中随增龄的变化情况有差异：在DMFH(-)组中HOMA-IR及Matsuda Indcx随着增龄无显著的变化趋势,而在DMFH(+)组中反映肝脏胰岛素抵抗的HOMA-IR随着增龄而升高,反映全身胰岛素敏感性的Matsuda Index随着增龄而降低,结果均有统计学意义。
5)DMFH(+)组与DMFH(-)组在各个年龄段中反映胰岛素分泌的指标(HOMA-B(除外60-69岁纤)、△130/△G30(除外50-59岁组))无差别。
6)在40岁以上各个年龄组的男性中,反映胰岛功能的指标(D130、D1120)在DMFH(-)(?)均高于DMFH(+)组,结果有统计学意义
7)在各个年龄段中反映全身胰岛素敏感性的指标Matsuda指数在DMFH(-)组均高于DMFH(+)组,结果仃统计学意义。在30岁以上各个年龄组的男性中,反映肝脏胰岛素抵抗的指标(HOMA-IR)DMFH(-)组均低于DMFH(+)组,结果有统计学意义。
结论DM家族史的影响并非一成不变,而与增龄及其相关的环境因素存在交互作用,这种影响主要体现在胰岛素作用上,在男性各个年龄组DMFH(+)组胰岛素敏感性均低于DMFH(-)组；在DMFH(-)组中HOMA-IR及Matsuda Index随着增龄无显著的变化趋势,而在DMFH(+)组中反映肝脏胰岛素抵抗的HOMA-IR随着增龄而升高,反映全身胰岛素敏感性的Matsuda Index随着增龄而降低。
Part1. Ageing related changes of insulin secretion and insulin sensitivity among normal glucose tolerance individuals in China
Objective: To investigate ageing related changes of insulin secretion and insulin sensitivity among normal glucose tolerance (NGT) individuals in China.
Methods:34239individuals were included in the analysis, all of which were described as NGT by75g oral glucose tolerance test (75gOGTT) according to the diagnosis criterion of WH01999. Homa-B, AI30/AG30,IiisAuc30/GIuAuc30,1nsAiic120/G1uAuc120were calculated to estimate insulin secretion; Honia-IR and Matsuda index were calculated to estimate insulin sensitivity; Dispositon index: Homa-B/Hoina-IR,D130and D1120were calculated to estimate13-cell function.
Results: In univariate linear regression, Homa-B, AI30/AG30InsAuc30/GluAuc30and Homa-IR were negatively correlated with age, Matsuda Index was positively correlated with age among men and overall, while no correlation was found between Horna-IR/Matsuda Index and ageing among women. In mutilivariate linear regression, the results among men and overall still existed after adjusted for BMI and waist circumference; while there was no correlation between Homa-B and ageing among women, Matsuda Index was positively correlated with age and Homa-IR were negatively correlated with age among women after adjusted for BMI and waist circumference. No linear correlation was found between Homa-B/I loina-lR and agcing, D130and D1120were negatively correlated with age in both uni',-0Mriate <
Part2. Characteristics of type2diabetes mellitus in the newly diagnosed patients of different age groups
Objective:To investigate the clinical metabolic characteristics of type2diabetes mellitus (T2DM) in newly diagnosed patients of different age groups.
Methods:2908individuals with no previous medical history of diabetes mellitus were included in the analysis, all of which were described as T2DM by75g oral glucose tolerance test (75gOGTT) according to the diagnosis criterion of WHO1999. These newly diagnosed DM patients were divided into three age groups:youth (
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