摘要
目的：探讨非糖尿病退休人群血清3-DG水平分布,3-DG水平与血糖代谢紊乱及其中医证型关系。方法：取苏州市中医院保健科退休体检人员,年龄≥50岁,男女不限,排除糖尿病及肾脏疾病、肾功能不全等影响3-DG水平者。测定该人群血清3-DG水平(初检),评估其3-DG水平增高的发生率；并分析相关因素与血清3-DG水平的关系。第2年末,对上述人群中血清3-DG水平增高者(同时随机抽取3-DG水平正常者作对照)复检测定血清3-DG水平,同时作口服糖耐量试验(OGTT)及胰岛素释放试验(IRI)；辨证分析糖代谢紊乱初发人群及高3-DG者的中医证型及病因病机特点。结果：1)初检结果：有36.57%的退休人员血清3-DG水平>70ng/ml,而3-DG>300ng/ml者为10.45%；60-69年龄组的3-DG水平及3-DG>70ng/ml者占比率较50～59年龄组明显增高(p分别<0.01,0.05),二组3-DG>300ng/ml人群所占比差异无统计学意义(p>0.05)；肥胖组血清3-DG水平高于超重组,超重组人群血清3-DG水平高于正常组(p均>0.05),BMI在>26间者3-DG水平最高,与<24组及24～26组比较有统计学意义(p均<0.05)。非清淡饮食者血清3-DG水平高于清淡饮食者(p>0.05)。2)第二年末：50～59和60～69岁二组的血清3-DG>70ng/ml者各有64.29%和93.75%(p=0.072),各有7/14例和9/16例为持续高3-DG者(p=0.999),各有2/14例和6/16例为3-DG不稳定增高者(p=0.226)。两年龄组及两BMI组的空腹和餐后2h血糖、空腹胰岛素水平及胰岛素敏感性指标均无统计学差异。3)有72.73%表现为持续高3-DG水平。持续高3-DG组的3-DG水平高于3-DG不稳定组及正常3-DG组(p分别<0.05、0.01)。与3-DG不稳定组和正常3-DG组相比,持续高3-DG组的空腹血糖增高(p分别<0.05和0.01),餐后1h、2h及平时血糖(HbAlc)增高(p>0.05)；空腹胰岛素水平升高(p均<0.05),胰岛素敏感指数下降(p均<0.01),胰岛素抵抗指数增高(p均<0.01)；糖耐量异常的发生率最高(p>0.05)；3-DG不稳定组与正常3-DG组之间各指标未见显著性差异；相关性分析显示,3-DG与空腹血糖(r=0.401)、空腹胰岛素(r=0.414)、胰岛素抵抗指数(r=0.492)呈正相关、与胰岛素敏感指数(r=-0.492)呈负相关。三组间β细胞功能指数及ΔI60/AG60未见明显差异,但经IR校正后餐后1h分泌指数低于3-DG不稳定组(p<0.05),显著低于正常3-DG组(p<0.05)。4)糖尿病前期及初诊糖尿病患者的中医证型以阴虚证及湿热证为主,持续高3-DG者的证候表现与其一致。结论：年龄及肥胖可能是非糖尿病退休人群血清3-DG水平增高的影响因素；老年人持续高3-DG水平可导致糖调节损伤(包括空腹血糖受损及糖耐量降低),3-DG可能是老年人糖代谢紊乱、糖尿病发生的风险因子之一,其机制可能是胰岛素敏感性下降伴餐后胰岛素分泌不足；湿热阴虚为3-DG导致老年糖尿病发病的主要病因病机。
Object: We detected the serum level of3-Deoxyglucosone (3-DG) of the elderly without diabetes, then investigated the relationship between3-DG and the disorder of glycometabolism, as well as the syndrome of TCM. Methods:We studied the retired people beyond the age of50years of women and55years of men, who visited the department of health of Chinese medicine hospital of Soochow. The subjects had a history of hyperglycosemia and nephritic which could affect the level of serum3-DG were excluded when assessing the level of plasma3-DG of non-diabetic. We assayed their serum levels of3-DG (initial inspection) and evaluated the ratio of high level among the elderly. On the other hand, we analyzed the possible factors for3-DG raise. Meanwhile, we investigated the effects diets conducted for3-DG raise by a questionnaire. Subjects who got high levels of3-DG were asked to remeasure serum3-DG after2years, and subjects had normal level of3-DG were random sampled as the control group. Every subject also took an oral glucose tolerance test-insulin radioimmunoassay (OGTT-IRI) after2years. Last, we differentiated the syndromes of the disorder of glycometabolism in primary state with TCM, as well as the syndromes of high level of3-DG, and investigated the relationship between them. Results:1) the results of initial inspection:49subjects (36.57%) of the134retired people had the level of serum3-DG>70ng/ml, while14subjects (10.45%)>300ng/ml; compared with50-59age group,60～69age group had a higher level of3-DG and much larger constituent ratio of people had3-DG>70ng/ml (both p<0.05), no difference was found in the constituent ratio of the3-DG>300ng/ml between the two groups (p>0.05); obesity group had a higher level of3-DG than overweight group, and overweight group had a higher level of3-DG than normal weight group, both p>0.05, and the subjects with BMI between≥26had the highest level of3-DG, compared with<24and24～26group, both p<0.05. The subjects with non-light diet had higher levels of serum3-DG than the light diet(p>0.05).2)2years later, the ratio of serum3-DG>70ng/ml in50～59and60～69age groups were64.29%and93.75%, respectively, approached significance (p=0.072); The people of continuing high level of3-DG in this two age group were7/14and9/16, with no difference (p=0.999),2/14in50～59group and6/16in60～69group that level of3-DG were fluctuating (p=0.226); the results suggested that age maybe one reason affected the level of serum3-DG. And it didn't show any difference of fasting blood glucose, postprandial blood glucose with2hours after meal, fasting insulin, and insulin sensitivity indexes between the two age groups and BMI groups.3) It was about72.73%of the subjects had continuing high level. The continuing high group had the highest level of3-DG, compared with the normal and fluctuating group, the p were<0.01, and<0.05. The continuing high group had a higher level of fasting blood glucose, postprandial blood glucose (1hours and2hours after meals), HbAlc and fasting insulin, compared with the normal and fluctuating groups, but a lower insulin sensitivity index; the continuing high group had the highest incidence rate of disorder of glycometabolism, compared with the other two groups(but p>0.05). Statistically significant correlations between3-DG level and fasting blood glucose (r=0.401), fasting insulin (r=0.414), HOMA insulin resistance (r=0.492), as well as insulin sensitivity index (r=-0.492) were found. But the HOMA β cell index and△I60/△G60among the three groups were similar. But the△I60/△G60of the continual high group was significantly lower than the fluctuating group (p>0.05), and normal group (p<0.05) when given IR correction.4) Yin-deficiency and dampness-heat syndrome were the main syndromes of prediabetic state and new diabetics, as well as the of high level of3-DG. Conclusion:Age and obesity maybe the reasons for serum3-DG level elevated in elderly without diabetes, a continuing high level of3-DG could result in impaired glucose regulation (conclude impaired fasting glucose and impaired glucose regulation).3-DG maybe one of the risk factors for disorder of glycometabolism, and leading to the development of diabetes with the mechanism of influent the sensitivity of insulin, consequently lead to insulin resistance and insufficient insulin after meals in elderly. And a dmapness-heat damages Yin is the main pathogenesis of3-DG conducts on the development of diabetes.
引文
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