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[目的]通过高葡萄糖钳夹技术精确评价正常、肥胖和2型糖尿病者胰岛β细胞功能和胰岛素抵抗差异,探讨肥胖和2型糖尿病发病机制。[方法]选择正常者10人(正常对照组)、肥胖和2型糖尿病者各15人(肥胖组和糖尿病组),应用高葡萄糖钳夹技术进行研究,观测钳夹过程中胰岛素分泌情况,评价胰岛β细胞功能状态,计算胰岛素敏感指数,了解胰岛素抵抗情况。[结果]①3组均4～8min达到目标高糖平台并维持钳夹结束,平均葡萄糖输注速度正常对照组和肥胖组均高于2型糖尿病组(F=1128.17,ν=2,P=0.0000),正常对照组和肥胖组比较无统计学差异(t=1.990,P=0.059);②3组胰岛素双相分泌曲线形态相似,肥胖组曲线微高于正常组;糖尿病组胰岛素1相和2相分泌曲线均显著低于正常组,各项指标差异均有统计学意义(P﹤0.01或P﹤0.05);③正常组和肥胖组平均葡萄糖代谢率无统计学差异,但显著高于糖尿病组(P﹤0.01或P﹤0.05);④正常、肥胖和2型糖尿病胰岛素敏感指数分别是(15.56±2.47)、(14.26±2.36)和(10.34±3.68)mg·kg-1·min-1/mU/L(F=13.71,ν=2,P=0.000)。[结论]①高葡萄糖钳夹成功建立,评价了不同人群的胰岛β细胞功能和机体胰岛素抵抗的差异;②代偿性胰岛素分泌增多与肥胖相关;③2型糖尿病者胰岛β细胞受损,普遍存在胰岛素分泌缺陷和(或)胰岛素抵抗。
[Objective] To accurately evaluate the difference of pancreatic β-cell function and insulin resistance in normal, obese and type 2 diabetic patients by means of high glucose clamp and to explore the pathogenesis of obesity and type 2 diabetes mellitus. [Methods] Ten normal subjects (normal control group), 15 obese and type 2 diabetic patients (obese group and diabetic group) were selected. High glucose clamp technique was used to study the insulin secretion during the clamp. Islet β-cell function status, calculate the insulin sensitivity index, understand the situation of insulin resistance. [Results] ① All patients in 3 groups reached the target high glucose platform within 4 ~ 8 min and maintained the end of clamp. The average glucose infusion rate was normal in control group and obesity group than in type 2 diabetes group (F = 1128.17, ν = 2, P = 0.0000 (T = 1.990, P = 0.059). ② The morphology of insulin biphasic secretion in group 3 was similar, and the curve in obesity group was slightly higher than that in normal group. The level of insulin in phase 1 and phase 2 in diabetic group was significantly higher than that in normal group (P <0.01 or P <0.05) .③The mean glucose metabolic rate in normal group and obesity group was not significantly different, but was significantly higher than that in diabetic group (P < P <0.01 or P <0.05) .④The insulin sensitivity index of normal, obese and type 2 diabetic patients were (15.56 ± 2.47), (14.26 ± 2.36) and (10.34 ± 3.68) mg · kg -1 · min -1 / mU /L(F=13.71,ν=2,P=0.000). [Conclusion] ①High glucose clamp was successfully established to evaluate the difference of pancreatic β-cell function and body insulin resistance in different populations; ②The compensatory insulin secretion increased and obesity related; ③ The islet β cells were impaired and widespread in type 2 diabetes mellitus Insulin secretion deficiency and / or insulin resistance.