目的 研究血糖“正常”的单纯性肥胖患者胰岛素抵抗与B细胞功能的关系，探讨游离脂肪酸（FFA）在2型糖尿病（T2DM）发病中的作用。方法 10例血糖“正常”的单纯性肥胖患者和10例年龄、生活习惯相匹配的非肥胖者（对照），均不吸烟、血压及血胆固醇正常。所有研究对象均完成以下检查：①空腹血脂及FFA。②血清免疫活性胰岛素（IRI）,前列胰岛素（PI）及真胰岛素（TI）；⑤静脉注射葡萄糖后早相胰岛素分泌反应（AIR）；④正常血糖高胰岛素钳夹试验，评价外周组织葡萄糖的摄取率（GDR）结果 肥胖患者IRI、PI和TI增高，PI/（PI+TI）比值也高于对照组（P<0.01）。肥胖患者AIR增高，曲线下面积也高于对照组（P<0.05），但肥胖患者在3、5及10 nun的血糖也高于对照组（P<0.05）。肥胖组达到稳态时GDR明显降低∽<O 05）。肥胖组血脂除TG增高（P<0.05）外，其余正常。血FFA浓度高于正常组妒<0.05）。肥胖组血FFA与GDR成负相关γ=-0.767，（P<0.01）。结论 血糖“正常”的单纯性肥胖患者存在外周胰岛素抵抗与B细胞功能异常，且二者可能同时发生。高FFA血症可导致外周胰岛素抵抗与B细胞功能异常。

Objective: To evaluate the relationship between insulin resistance and endothelial function in type 2 diabetes patients withor without microalbuminuria and to explore the pathophysiological mechanisms of the increased macrovascular risk in type 2diabetes mellitus. Methods: Twelve type 2 diabetes patients with microalbuminuria (urinary albumin 30-300_g/mg creatinine,DM-MA) and 12 type 2 diabetes patients without microalbuminuria (urinary albumin <30_g/mg creatinine, DM-NA) wererecruited, matched for their sex, age, body mass index (BMI), diabetes duration, antidiabetic therapy. Their hemoglobin (HbA1C)was less than 7.5% and the blood pressure was lower than 140/90 mmHg. None had evidence of macrovascular disease and serumcholesterol levels were normal. Twelve healthy volunteers (C) were enrolled as controls. All subjects received a hyperinsulinemiceuglycemic clamp study (insulin infusion rate, 120 mU/m2/min) to assess the peripheral glucose disposal rate (GDR) in thesteady state and had a high-resolution ultrasonography to measure vasodilation in the brachial artery diameter in responseto reactive hyperemia (endothelium-dependent) and administration of glyceryl trinitrate (endothelium-independent). Plasmafree fatty acids (FFAs), plasminogen activator inhibitor type I (PAI-1), and von Willebrand factor (vWF) were also measured.Results: The GDR was lower in type 2 diabetes patients with microalbuminuria (7.90

在4个临床中心观察吡格列酮（104 例）和二甲双胍（104例）治疗12周对2型糖尿病的疗效并进行比较，结果显示这两种药物均使空腹和餐后血糖、HbA1c明显下降（均P<0.05），两组疗效相似。两组不良事件发生率相似。