新诊断酮症倾向2型糖尿病临床特点及胰岛素抵抗分析

发布时间：2018-02-05 21:31

  本文关键词： 酮症倾向2型糖尿病 新诊断 胰岛素抵抗　出处：《新疆医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的探讨新诊断酮症倾向2型糖尿病(KPD)患者的临床特征并分析其胰岛素抵抗程度。方法收集新诊断的2型糖尿病(T2DM)患者327例,其中KPD者211例,无酮症的T2DM者116例,比较并分析两组临床特点及胰岛素抵抗相关指标。结果1.KPD组患者体质指数(BMI)(26.77±0.30kg·m-2)高于T2DM组(26.33±0.63kg·m=2),腰臀比(0.94±0.01)高于T2DM组(0.92±0.01),空腹血糖(FPG)(10.52±0.29mmol·L-1)高于T2DM组(9.01±0.52mmol·L-1),甘油三酯(TG)(3.84±0.29mmol·L-1)高于T2DM组(2.01±0.30mmol·L-1),胰岛素抵抗指数(HOMA-IR)(5.81±1.22)低于T2DM组(6.94+1.95),合并脂肪肝者率KPD组(69.3%)低于T2DM组(72.40%),合并颈动脉粥样硬化率KPD组(42.6%)低于T2DM组(44.8%),但上述差异均无统计学意义(P0.05)。2.KPD组患者平均发病年龄(38.44±0.65岁)低于T2DM组(44.72±1.24岁),诊断时平均糖化血红蛋白KPD组(11.54%±0.17%)高于T2DM组(8.46%±0.31%),男性患者比例KPD组(86.7%)高于T2DM组(58.6%),餐后2小时血糖(2hPPG)KPD组(18.94±0.32mmol·L-1)高于T2DM组(17.15±0.65mmol·L-1),总胆固醇(TC)水平KPD组(4.88± 0.12mmol·L-1)高于T2DM组(4.18±0.22mmol·L-1),上述差异均有统计学意义(均P0.05)。3.年龄在20-40岁之间,KPD组较T2DM组有更高的HbAlC、由TG和IFP G计算所得简易指数(TyG)、由TG和2hPPG计算所得简易指数(TyG2)和TG/HDL-c比值(均P0.05),而其它年龄段,差异无统计学意义。4.根据性别划分,男性KPD组较T2DM组存在更高的餐后2小时胰岛素(2hPINS)、TC、TyG2、TG/HDL-c及糖尿病周围神经病变患病率,(均P0.05)；女性：KPD组较T2DM组存在更高的HbAlC、糖尿病周围神经病变患病率,(均P0.05)。结论1.在新诊断的T2DM患者中,KPD者较非酮症T2DM患者发病早、血糖水平更高、血脂紊乱更明显,并且男性KPD者较非酮症T2DM患者存在更严重的胰岛素抵抗,但女性患者的胰岛素抵抗无明显差异。2.在新诊断的T2DM青壮年(20-40岁)患者中,酮症倾向患者较非酮症患者存在更严重的胰岛素抵抗,在其他年龄段未见上述差异。
[Abstract]:Objective to investigate the clinical features and insulin resistance of newly diagnosed type 2 diabetes mellitus (KPD). Methods 327 newly diagnosed patients with type 2 diabetes mellitus (T2DM) were collected. There were 211 cases of KPD and 116 cases of T2DM without ketosis. Results 1. Body mass index (BMI) of KPD patients was 26.77 卤0.30kg 路m ~ (-2) higher than that of T2DM group (P < 0.05). 26.33 卤0.63 kg 路mm2). WHR (0.94 卤0.01) was higher than that in T2DM (0.92 卤0.01). The fasting blood glucose level was 10.52 卤0.29 mmol 路L ~ (-1) in FPG group and 9.01 卤0.52 mmol 路L ~ (-1) in T2DM group. Triglyceride triglyceride (TGG) was 3.84 卤0.29 mmol 路L ~ (-1) higher than that of T2DM (2.01 卤0.30 mmol 路L ~ (-1)). The insulin resistance index (HOMA-IRI) was 5.81 卤1.22, lower than that in T2DM group (6.94 1.95). The rate of fatty liver in KPD group (69.3%) was lower than that in T2DM group (72.40%), and the rate of carotid atherosclerosis in KPD group (42.6%) was lower than that in T2DM group (44.8%). However, there was no significant difference in the mean age of onset between the KPD group (38.44 卤0.65 years) and the T2DM group (44.72 卤1.24 years). The mean value of glycosylated hemoglobin in KPD group (11.54% 卤0.17%) was higher than that in T2DM group (8.46% 卤0.31%). The proportion of male patients in KPD group (86.7%) was higher than that in T2DM group (58.6%). 2 h postprandial blood glucose was 18.94 卤0.32 mmol 路L -1 in KPD group and 17.15 卤0.65 mmol 路L -1 in T2DM group. The level of TC in KPD group was higher than that in T2DM group (4.88 卤0.12 mmol 路L ~ (-1) vs 4.18 卤0.22 mmol 路L ~ (-1)). All the above differences were statistically significant (P0.05. 3). The HbAlC was higher in KPD group aged 20-40 years than in T2DM group. The simple index was calculated by TG and IFP G, the simple index was calculated by TG and 2hPPG, and the ratio of TG/HDL-c (both P0.05) was calculated by TG and PPG. However, there was no significant difference in other age groups. 4. According to sex, there was a higher level of 2 hour postprandial insulin in male KPD group than in T2DM group. The prevalence of TG/HDL-c and diabetic peripheral neuropathy (P 0.05); The prevalence of diabetic peripheral neuropathy in female KPD group was higher than that in T2DM group (all P 0.05). Conclusion 1. In newly diagnosed T2DM patients. 2. The onset of KPD was earlier than that of non-ketotic T2DM patients, the level of blood glucose was higher, the disorder of blood lipid was more obvious, and the male patients with KPD had more severe insulin resistance than those with non-ketotic T2DM. However, there is no significant difference in insulin resistance in female patients. 2. In newly diagnosed T2DM patients aged 20-40 years, ketosis-prone patients have more severe insulin resistance than non-ketotic patients. These differences were not found in other age groups.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R587.1
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本文编号：1492818