本文選題：糖尿病 + 家族史　； 參考：《第二軍醫(yī)大學(xué)》2017年碩士論文

【摘要】：研究目的:糖尿病(diabetes mellitus,DM)是一種胰島分泌胰島素不足或機(jī)體無法有效利用胰島素的慢性疾病,而全球糖尿病患者數(shù)量從1980年的1億八百萬到2014的4億2千2百萬,以18歲以上人群計算,患病率從1980年的4.7%增加到了2014年的8.5%,已經(jīng)成為全球性公共衛(wèi)生問題。我國作為人口基數(shù)龐大的發(fā)展中國家,20歲以上人群中患病率高達(dá)15.5%。而在糖尿病中,2型糖尿病占絕大多數(shù),以高血糖、胰島素抵抗(insulin resistance,IR)和相對胰島素缺乏為疾病特點(diǎn)。而且2型糖尿病患病率隨年齡增長而增加,在60-74歲之間會達(dá)到高峰,幾乎三分之一的老年人患有2型糖尿病,四分之三有糖調(diào)節(jié)受損,它的發(fā)生是遺傳因素和行為、生活方式共同作用下的結(jié)果。本研究以長期在上海市居住的健康人群作為研究對象,對不同年齡狀態(tài)、不同遺傳背景的人群β細(xì)胞功能及胰島素抵抗特點(diǎn)進(jìn)行研究,對評估上海市居民的胰島β細(xì)胞功能狀態(tài)、發(fā)現(xiàn)2型糖尿病高危人群具有重要意義。研究方法:本研究是觀察性研究,研究對象來自于上海市衛(wèi)生與計劃生育委員會公共衛(wèi)生三年行動計劃《上海市成人自身免疫性甲狀腺疾病(AITD)篩查及評估系統(tǒng)》重點(diǎn)項(xiàng)目,自2016年11月至2017年2月以南橋鎮(zhèn)社區(qū)、曹路鎮(zhèn)社區(qū)、江橋鎮(zhèn)社區(qū)、天平街道社區(qū)、南橋街道社區(qū)為調(diào)查地點(diǎn),每個社區(qū)隨機(jī)抽取10個居委會,居委會在管轄小區(qū)以每戶一名隨機(jī)抽取一定數(shù)量受試者,每戶選擇生日離調(diào)查日期最近的家庭成員為調(diào)查對象,共計隨機(jī)抽取了344名18歲至65歲在上海居住時間大于半年的居民為研究對象,抽樣方法為居委會隨機(jī)抽取一定戶數(shù),以每戶家庭成員中生日日期最接近流行病學(xué)調(diào)查期者為研究對象,并排除了懷孕,既往有糖耐量異常或糖尿病病史,合并多囊卵巢綜合癥、自身免疫性疾病等可能影響血糖水平的疾病,合并有骨折、嚴(yán)重精神障礙或癡呆癥、臥床、肝炎、結(jié)核病、艾滋病或其他傳染病以及其他嚴(yán)重重要臟器疾病,長期口服糖皮質(zhì)激素、避孕藥等影響血糖水平藥物的受試者。采集受試者2型糖尿病家族史相關(guān)信息,測量身高、體重,檢測血脂水平、空腹靜脈血漿葡萄糖濃度、空腹靜脈血漿胰島素濃度、口服糖耐量試驗(yàn)(oral glucose tolerance test,OGTT)后2小時靜脈血漿葡萄糖濃度、口服糖耐量試驗(yàn)后2小時靜脈血漿胰島素濃度,計算HOMA-β、HOMA-IS、HOMA-IR、GUTT-ISI指數(shù)評估胰島β細(xì)胞功能與胰島素抵抗。通過針對不同年齡段、不同遺傳背景、不同遺傳強(qiáng)度進(jìn)行分組,經(jīng)正態(tài)分布檢驗(yàn)后計算均數(shù)及標(biāo)準(zhǔn)差,以Student-Newman-Keuls多重比較組間差異。結(jié)果:上海各社區(qū)344名受試者中,根據(jù)1999年WHO糖尿病專家委員會報告標(biāo)準(zhǔn),糖尿病(DM)患者37例,空腹血糖受損(IFG)者4例,糖耐量減低(IGT)者26例,正常血糖(NGR)者277例。電話回訪家族史相關(guān)信息,采集到家族史信息者共計292例,其中家族史陽性者90例,家族史陰性者202例,家族史陽性者中父系遺傳者40例,母系遺傳者31例,雙親遺傳者11例,僅同胞有2型糖尿病者8例。校正BMI及甘油三酯水平后,針對正常血糖人群進(jìn)行分析,以年齡分為8組,即18歲-24歲(YrA組)、25歲-30歲(YrB組)、31歲-36歲(YrC組)、37歲-42歲(YrD組)、43歲-48歲(YrE組)、49歲-54歲(YrF組)、55歲-60歲(YrG組)、61-65歲分組(YrH組),總體趨勢上HOMA-β、HOMA-IS、GUTT-ISI在年齡較高組別偏低,SNK檢驗(yàn)表明YrA組、YrB組、YrC組的HOMA-β分別較YrF組、YrG組、YrH組別具有明顯差異,YrB組的GUTT-ISI較除YrC組外的其余組別均具有顯著差異,而HOMA-IS指數(shù)組間無明顯差異。根據(jù)家族史情況及遺傳強(qiáng)度分為家族史陽性組(FH+組)、家族史陰性組(FH-組)、父系遺傳(FHF組)、母系遺傳(FHM組)、雙系遺傳(FHB組)、輕度家族史組(FH1組)、中度家族史組(FH2組)、重度家族史組(FH3組),其中輕度家族史指有1個二級親屬患有糖尿病,中度家族史指1個一級親屬+1個二級親屬/1個一級親屬/2個以上來自同一家系的二級親屬,重度家族史指至少2個一級親屬/1個一級親屬+2個以上來自同一家系的二級親屬。經(jīng)Student’s t檢驗(yàn),FH+組HOMA-β較FH-組高。經(jīng)Student’s t及SNK檢驗(yàn),其余指標(biāo)組間無明顯差異。結(jié)論:1.通過多因素組間比較,年齡為胰島素抵抗影響因素,其中49歲以后人群胰島素敏感性及β細(xì)胞分泌功能存在隨年齡下降的表現(xiàn)。2.具有2型糖尿病家族史的正常血糖人群β細(xì)胞功能較無家族史者好,其余不同遺傳背景、遺傳家系、遺傳強(qiáng)度之間的胰島β功能、胰島素敏感性無明顯變化規(guī)律及相關(guān)性。不同年齡組之間各項(xiàng)指標(biāo)無明顯統(tǒng)計學(xué)差異,但胰島素分泌及敏感性有隨年齡下降的趨勢。
[Abstract]:Research objectives: diabetes mellitus (DM) is a chronic disease of islet secreting insulin deficiency or the body's inability to use insulin effectively, and the number of diabetic patients worldwide from 1 billion to 2014 in 1980 is 422 million over 18 years of age, and the prevalence rate has increased from 4.7% in 1980 to 8.5% in 2014, As a global public health problem, as a developing country with a large population base, the prevalence rate of people over 20 years of age is up to 15.5%. while in diabetes, type 2 diabetes is the majority, with hyperglycemia, insulin resistance (insulin resistance, IR) and relative islet deficiency as the disease characteristics. And the prevalence rate of type 2 diabetes is associated with the disease. The increase of age and the peak between 60-74 years of age, almost 1/3 of the elderly people with type 2 diabetes and 3/4 impaired glucose regulation, is the result of a common effect of genetic factors and behavior and life style. This study is based on a healthy population living in Shanghai for a long time. The study of beta cell function and insulin resistance in people with different genetic backgrounds is of great significance for assessing the function status of islet beta cells in Shanghai residents and finding the high risk population of type 2 diabetes. The research method is an observational study, and the research object is from the public health of the Shanghai health and Family Planning Commission. The three year action plan, "Shanghai adult autoimmune thyroid disease (AITD) screening and evaluation system > key project, from November 2016 to February 2017, from the community in the town of Nan Qiao Town, the community in the town of Cao Lu Town, the community of Jiangqiao Town, the community of the Tian Ping Street, the community of the South Bridge, the neighborhood committee of each community, the neighborhood committee is under the jurisdiction of the neighborhood committee. Each household selected a certain number of subjects at random. Each household selected the nearest family members from the date of the date of the birthday to investigate. A total of 344 residents aged 18 to 65 and 65 years old were selected for the study. The date is most close to the epidemiological study, and excludes pregnancy, past glucose tolerance or diabetes, polycystic ovary syndrome, autoimmune diseases, and other diseases that may affect blood sugar levels, including fractures, severe mental disorders or idiosis, bed, hepatitis, tuberculosis, AIDS, or other infections. Patients with disease and other serious organ diseases, long-term oral glucocorticoids, contraceptives, and other subjects affecting blood glucose levels were collected. The family history of subjects with type 2 diabetes was collected, height, weight, blood lipid level, fasting plasma glucose concentration, fasting venous plasma insulin concentration, oral glucose tolerance test (ORA L glucose tolerance test, OGTT) venous plasma glucose concentration after 2 hours, 2 hours intravenous plasma insulin concentration after oral glucose tolerance test, and calculate HOMA- beta, HOMA-IS, HOMA-IR, GUTT-ISI index to evaluate islet beta cell function and insulin resistance. Result: among 344 Shanghai community subjects, 37 cases of diabetes (DM), 4 cases of impaired fasting blood glucose (IFG), 26 cases of impaired glucose tolerance (IGT) and 277 cases of normal blood glucose (NGR), among 344 subjects in each community of Shanghai, according to the report standard of the 1999 WHO diabetes expert committee. A total of 292 family history information were collected, including 90 family history positive, 202 family history negative, 40 paternal hereditary, 31 maternal inheritance, 11 parent hereditatrix and 8 of type 2 diabetes mellitus. After correction of BMI and triglyceride level, it was aimed at normal blood glucose. The population was divided into 8 groups, which were divided into 8 groups, namely, 18 years old (group YrA), 25 year old -30 years (group YrB), 31 year old -36 years (group YrC), 37 year old -42 (YrD group), 43 year old -48 (YrE group), 49 year old -54 years (YrF group), 55 years old (Group), 61-65 year old group (Group). Group YrC, HOMA- beta in group YrC, YrG and YrH groups were significantly different. The GUTT-ISI in group YrB had significant differences compared with the other groups except the YrC group, but there was no significant difference between the HOMA-IS index group and the family history and the genetic intensity. Heredity (group FHM), double inheritance (group FHB), mild family history group (group FH1), moderate family history group (group FH2), severe family history group (group FH3), of which 1 two degree relatives have diabetes, moderate family history refers to 1 first-degree relatives +1 two relative /1 first relatives /2 more than two degree relatives from the same family, and severe family history. Family history refers to the two degree relatives of /1 first degree relatives of at least 2 first degree relatives and more than +2 from the same family. After Student 's t test, HOMA- beta in group FH+ is higher than that of FH- group. There is no significant difference between the other index groups after Student' s t and SNK test. Conclusion: 1. through multiple factors group comparison, age is the influence factor of insulin resistance, of which 49 years after age. The expression of insulin sensitivity and beta cell secretory function in the population decreased with age..2. with the family history of type 2 diabetes, the function of beta cells in normal blood glucose population is better than those without family history. The rest of the genetic background, genetic family, the islet beta function between the genetic intensity and the islet sensitivity have no obvious change law and correlation. There was no significant difference in age between groups, but insulin secretion and sensitivity decreased with age.
【學(xué)位授予單位】：第二軍醫(yī)大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R587.1

【參考文獻(xiàn)】

相關(guān)期刊論文 前5條

1 廖涌;;中國糖尿病的流行病學(xué)現(xiàn)狀及展望[J];重慶醫(yī)科大學(xué)學(xué)報;2015年07期

2 李銳;盧偉;賈偉平;黎衍云;施亮;劉美霞;耿國柱;傅華;施榕;史君衡;史虹莉;張勝年;;上海市2型糖尿病患病情況現(xiàn)狀調(diào)查[J];中華醫(yī)學(xué)雜志;2006年24期

3 韓學(xué)堯,紀(jì)立農(nóng),周翔海;2型糖尿病一級親屬的胰島素敏感性和胰島β細(xì)胞功能[J];中華醫(yī)學(xué)雜志;2004年21期

4 楊澤;中國中老年人糖尿病和糖耐量異常的流行病學(xué)研究[J];中華流行病學(xué)雜志;2003年05期

5 向紅丁,吳緯,劉燦群,李康,馮晉光,張英廷,王鳳歧,閻勝利,王春儉,徐躍初,徐端衍,傅祖植,劉尊永,李天麟,白錦,富振英,王克安;1996年全國糖尿病流行病學(xué)特點(diǎn)基線調(diào)查報告[J];中國糖尿病雜志;1998年03期

，

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