Li Fang-Ping, Zhang Si-Qing, Wang Fei, Huang Yin-Qiong, Fu Zu-Zhi, Yan Li
Department of Endocrinology and Metabolism, The Second Affiliated Hospital, Sun Yat-sen University, Guangzhou 510120, China. Email:
Zhonghua Nei Ke Za Zhi. 2009 Nov;48(11):940-3.
To investigate insulin resistance and islet beta cell function in type 2 diabetes mellitus (T2DM) and non alcoholic fatty liver disease (NAFLD).
Two hundred and six study subjects were classified into 4 groups. Hepatic insulin resistance index (HIR), HOMA insulin resistance index (HOMA-IR) and Matsuda index (MSI) were used to assess insulin resistance. HOMA-beta, early and late phase indexes of insulin secretion were used to evaluate islet beta cell function.
HIR in the NAFLD group and T2DM with NAFLD group were significantly higher than that in the control group and T2DM group (4.13 +/- 0.64, 4.03 +/- 0.69 vs 3.52 +/- 0.78, 3.53 +/- 0.64, P < 0.05), HOMA-IR in the T2DM with NAFLD group was significantly higher than that in the NAFLD group and T2DM group (3.35 +/- 2.69 vs 2.31 +/- 1.39, 2.40 +/- 1.55, P < 0.05). Early phase insulin secretion index in the NAFLD group was lower than that in the control group significantly (2.13 +/- 0.17 vs 2.61 +/- 0.13, P < 0.05), but there was no significant difference of HOMA-beta and late phase insulin secretion index between the NAFLD group and control group, HOMA-beta, early and late phase indexes of insulin secretion in the T2DM group and T2DM with NAFLD group were significantly lower than those in the control group.
Normal glucose tolerance NAFLD patients may present with insulin resistance, mainly hepatic insulin resistance. Islet beta cell function in the NAFLD patients show damage of early phase insulin secretion. Newly diagnosed T2DM with or without NAFLD patients generally present with insulin resistance, early and later phase insulin secretion dysfunction. Insulin resistance in patients with T2DM and NAFLD is more severe.
探讨2型糖尿病（T2DM）和非酒精性脂肪性肝病（NAFLD）患者的胰岛素抵抗及胰岛β细胞功能。
将206例研究对象分为4组。采用肝脏胰岛素抵抗指数（HIR）、稳态模型评估胰岛素抵抗指数（HOMA-IR）和松田指数（MSI）评估胰岛素抵抗。采用HOMA-β、胰岛素分泌早期和晚期指数评估胰岛β细胞功能。
NAFLD组和T2DM合并NAFLD组的HIR显著高于对照组和T2DM组（4.13±0.64，4.03±0.69 vs 3.52±0.78，3.53±0.64，P<0.05），T2DM合并NAFLD组的HOMA-IR显著高于NAFLD组和T2DM组（3.35±2.69 vs 2.31±1.39，2.40±1.55，P<0.05）。NAFLD组的胰岛素分泌早期指数显著低于对照组（2.13±0.17 vs 2.61±0.13，P<0.05），但NAFLD组与对照组之间的HOMA-β和胰岛素分泌晚期指数无显著差异，T2DM组和T2DM合并NAFLD组的HOMA-β、胰岛素分泌早期和晚期指数均显著低于对照组。
糖耐量正常的NAFLD患者可能存在胰岛素抵抗，主要为肝脏胰岛素抵抗。NAFLD患者的胰岛β细胞功能表现为胰岛素分泌早期受损。新诊断的T2DM患者无论有无NAFLD，一般均存在胰岛素抵抗及胰岛素分泌早期和晚期功能障碍。T2DM合并NAFLD患者的胰岛素抵抗更严重。
