Sindelka G, Skrha J, Prázný M, Hilgertová J
III. interní klinika 1. lékarské fakulty UK, Praha.
Vnitr Lek. 1999 Sep;45(9):540-4.
Insulin resistance is found patients with diabetes mellitus type 2 as well as in obese subject without diabetes. The objective of our investigation was to compare the action of insulin in morbidly obese subject with and without diabetes and in diabetic subject with different degrees of obesity. A total of 36 diabetic were examined, divided according to the BMI into morbidly obese (DMTO: BMI > 40 kg/m-2.n = 6) those with medium severe obesity (DMSO: BMI 31-40 kg.m-2.n = 16), with slight overweight DMLO. BMI 26-91 kg.m-2.n = 9) and non-obese diabetics (DMBO). BMI 21-26 kg.m-2.n = 5). The group of morbidly obese non-diabetic subject (NDTO, BMI > 40 kg.m-2.n = 5) and non-obese healthy subject (C, BMI < 26 kg.m-2, n = 12) served as control. All examined subject were of similar age the diabetic subject had similar values of indicator of diabetic control (HbA1c was 7.1 +/- 0.5%). The examination was made using the method of an isoglycaemic hyperinsulinaemic clamp on a Biostator at an insulin infusion rate of 1mU.kg-1.min-1 for a period of 20 minutes. The results of the index of tissue sensitivity to insulin revealed a markedly deteriorated action of insulin in morbidly obese diabetes and non-diabetics in relation to control group of healthy slim controls (M/I, DMTO: 12.4 +/- 7.3 and NDTO: 9.2 +/- 4.1, p < 0.001, mumol.kg-1.min-1 na mU.l-1 x 100), in midly and medium obese diabetics the insulin resistance was of difference grades (M/I, DMLO: 34.2 +/- 9.3, p < 0.05, and DMSO: 25.9 +/- 18.5 p < 0.001 mumol.kg-1.min-1 na mU.l-1 x 100. Non-obese diabetic and non-diabetic subject had a normal insulin action (M/I, DMBO: 58.3 +/- 29.4 and C: 48.9 +/- 5.0 mumol.kg-1.min-1 per mU.l-1 x 100. The metabolic glucose clearance differed however between diabetic and non-diabetic subject (MCRG, DMTO: 2.0 +/- 0.4, p < 0.001, DMSO: 3.8 +/- 2.4, p < 0.001, DMSO: 5.4 +/- 1.7, p < 0.05 v.s. C: 8.6 +/- 1.1 and NDTO: 3.8 +/- 1.5, p < 0.001 ml.kg-1.min-1). The statistical significance is related to the control group of slim healthy subject. From this ensues that no significant difference was found between slim diabetic and non-diabetic subjects in the majority of parameters expressing the action of insulin with the exception of the metabolic glucose clearance. At the same time the authors found in the whole group of 53 examined subject a statistically significant correlation between the BMI and the index of tissue sensitivity for insulin (M/I) (r = -0.55, p < 0.001). On examination of characteristics of insulin receptors on erythrocytes the authors found a reduced number in diabetic subject as compared with the two control groups (p < 0.05). It may thus be concluded from this investigation that the BMI has a decisive role in the action insulin.
胰岛素抵抗在2型糖尿病患者以及无糖尿病的肥胖个体中均有发现。我们研究的目的是比较患有和未患有糖尿病的病态肥胖个体以及不同肥胖程度的糖尿病个体中胰岛素的作用。总共检查了36名糖尿病患者，根据体重指数（BMI）分为病态肥胖组（DMTO：BMI>40kg/m²，n = 6）、中度严重肥胖组（DMSO：BMI 31 - 40kg/m²，n = 16）、轻度超重组（DMLO，BMI 26 - 31kg/m²，n = 9）和非肥胖糖尿病组（DMBO，BMI 21 - 26kg/m²，n = 5）。病态肥胖非糖尿病个体组（NDTO，BMI>40kg/m²，n = 5）和非肥胖健康个体组（C，BMI<26kg/m²，n = 12）作为对照组。所有检查的个体年龄相似，糖尿病个体的糖尿病控制指标值相似（糖化血红蛋白HbA1c为7.1±0.5%）。使用等血糖高胰岛素钳夹法在Biostator上进行检查，胰岛素输注速率为1mU·kg⁻¹·min⁻¹，持续20分钟。组织对胰岛素敏感性指数的结果显示，与健康苗条对照组相比，病态肥胖糖尿病患者和非糖尿病患者中胰岛素的作用明显恶化（M/I，DMTO：12.4±7.3和NDTO：9.2±4.1，p<0.001，μmol·kg⁻¹·min⁻¹ per mU·l⁻¹×100），中度和中度肥胖糖尿病患者的胰岛素抵抗程度不同（M/I，DMLO：34.2±9.3，p<0.05，和DMSO：25.9±18.5，p<0.001，μmol·kg⁻¹·min⁻¹ per mU·l⁻¹×100）。非肥胖糖尿病患者和非糖尿病个体具有正常的胰岛素作用（M/I，DMBO：58.3±29.4和C：48.9±5.0，μmol·kg⁻¹·min⁻¹ per mU·l⁻¹×100）。然而，糖尿病患者和非糖尿病个体之间的代谢性葡萄糖清除率不同（MCRG，DMTO：2.0±0.4，p<0.001，DMSO：3.8±2.4，p<0.001，DMSO：5.4±1.7，p<0.05 vs C：8.6±1.1和NDTO：3.8±1.5，p<0.001，ml·kg⁻¹·min⁻¹）。统计学意义与苗条健康个体对照组相关。由此得出，除了代谢性葡萄糖清除率外，在表达胰岛素作用的大多数参数方面，苗条糖尿病患者和非糖尿病患者之间未发现显著差异。同时，作者在总共53名检查的个体中发现BMI与组织对胰岛素的敏感性指数（M/I）之间存在统计学显著相关性（r = -0.55，p<0.001）。在检查红细胞上胰岛素受体的特征时，作者发现与两个对照组相比，糖尿病患者的受体数量减少（p<0.05）。因此，从这项研究可以得出结论，BMI在胰岛素作用中起决定性作用。
