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不同糖化血红蛋白水平的新诊断2型糖尿病患者胰岛功能的临床观察

来自:金沙赌玚下载  编辑:张倩 李际敏 李琳娜等|点击数:|2016-03-06

 

      【摘要】 目的    比较不同HbA1c水平的新诊断T2DM患者胰岛功能的变化。方法   将165例新诊断T2DM患者根据HbA1c水平分为A、B、C组,A组54例,6.0%≤HbA1c<7.0%,B组53例,7.0%≤HbA1c<9.0%,C组58例,HbA1c≥9.0%,采用标准餐试验联合胰岛素释放试验检测0、30、60、120 min血糖和胰岛素,胰岛β细胞分泌指数(HOMA-β)、ΔI30/ΔG30、I/GAUC 60~120评估胰岛功能,胰岛素抵抗指数(HOMA-IR)评估IR,Matsuda指数(ISIM)评估IS,处置指数(DI30、DI60~120)评价校正IS后的胰岛功能。  结果    随HbA1c升高,A、B、C组FPG[(7.7±0.8)vs(9.0±1.9)vs(13.4±3.2)mmol/L]、2 hPG[(12.03±1.23)vs(16.08±2.67)vs(23.58±3.99)mmol/L]、G0[(7.10±0.86)vs(8.93±1.59)vs(13.80±3.35)mmol/L]、G30[(10.16±1.86)vs(12.19±2.50)vs(16.98±3.78)mmol/L]、G60[(12.57±1.81)vs(15.03±2.72)vs(20.11±4.08)mmol/L]和G120[(11.49±2.48)vs(14.78±3.53)vs(21.05±4.43)mmol/L]逐渐升高,I0[(20.09±12.76)vs(18.74±7.88)vs(15.30±11.71)mIU/L]、I30[(38.92±12.59)vs(34.27±20.56)vs(23.95±16.55)mIU/L]、I60[(72.80±39.38)vs(52.96±32.48)vs(36.16±27.22)mIU/L]、I120[(106.62±61.09)vs(64.57±40.75)vs(43.09±23.08)mIU/L]、HOMA-β[(130.58±107.33)vs(74.68±38.34)vs(42.66±35.70)]、I/GAUC 60~120[(58.06±33.85)vs(28.90±18.90)vs(14.31±9.78)]和DI60~120[(458.22±174.30)vs(239.27±113.05)vs(89.91±49.93)]逐渐降低(P<0.05)。C组TG[(3.40±1.44)vs(1.89±0.88),(2.29±1.23)mmol/L]、HOMA-IR[(11.66±7.13)vs(6.30±3.66),(7.47±3.58)]较A、B组高,年龄[(45.10±9.30)vs(51.40±7.80),(49.70±8.80)岁]、ΔI30/ΔG30[(2.44±1.50)vs(8.27±6.33),(6.77±5.16)]和DI30[(13.86±7.23)vs(58.21±18.14),(45.31±17.99)]低(P<0.05)。Spearman相关性分析结果显示,HbA1c与HOMA-IR呈正相关,与HOMA-β、ΔI30/ΔG30、I/GAUC 60~120、DI30和DI60~120呈负相关。多元线性回归分析结果显示,DI60~120、HOMA-IR、HOMA-β为HbA1c的影响因素。  结论   随HbA1c水平升高,新诊断T2DM患者糖代谢紊乱加重,胰岛素分泌功能逐步减退,在HbA1c≥9.0%患者中尤为明显。
      【关键词】  糖尿病,2型;糖化血红蛋白;胰岛功能

       Comparison of pancreas islet function among patients with newly diagnosed type 2 diabetes mellitus at different hemoglobin A1c levels

      【AbstractObjective   To compare pancreas islet function among patients with newly diagnosed T2DM at different HbA1c levels.  Methods  165 patients with newly diagnosed T2DM were divided into three groups according to HbA1c levels: Group A 6.0%≤HbA1c<7.0% (n=54), Group B 7.0%≤HbA1c<9.0% (n=53), and Group C HbA1c≥9.0% (n=58). All patients underwent mixed meal tolerance test  and insulin release test. Plasma glucose and serum insulin were measured at 0, 30, 60, 120 min during the mixed meal tolerance test to calculate HOMA-β, ΔI30/ΔG30, I/GAUC 60~120 for the evaluation of beta cell function. HOMA-IR was calculated to evaluate insulin resistance. ISIM was calculated for insulin sensitivity assessment, and DI30 and DI60~120 were computed to estimate islet function after the adjustment of insulin sensitivity.  Results  With increased HbA1c, FPG [(7.7±0.8)vs(9.0±1.9)vs(13.4±3.2)mmol/L], 2 hPG [(12.03±1.23)vs(16.08±2.67)vs(23.58±3.99)mmol/L], G0 [(7.10±0.86)vs(8.93±1.59)vs(13.80±3.35)mmol/L], G30 [(10.16±1.86)vs(12.19±2.50)vs(16.98±3.78)mmol/L]、G60 [(12.57±1.81)vs(15.03±2.72)vs(20.11±4.08)mmol/L] and G120 [(11.49±2.48)vs(14.78±3.53)vs(21.05±4.43)mmol/L] increased, I0 [(20.09±12.76)vs(18.74±7.88)vs(15.30±11.71)mIU/L], I30 [(38.92±12.59)vs(34.27±20.56)vs(23.95±16.55)mIU/L], I60 [(72.80±39.38)vs(52.96±32.48)vs(36.16±27.22)mIU/L], I120 [(106.62±61.09)vs(64.57±40.75)vs(43.09±23.08)mIU/L], HOMA-β [(130.58±107.33)vs(74.68±38.34)vs(42.66±35.70)], I/GAUC 60~120 [(58.06±33.85)vs(28.90±18.90)vs(14.31±9.78)] and DI60~120 [(458.22±174.30)vs(239.27±113.05)vs(89.91±49.93)] decreased in A, B and C group (P<0.05). TG [(3.40±1.44)vs(1.89±0.88), (2.29±1.23)mmol/L] and HOMA-IR [(11.66±7.13)vs(6.30±3.66),(7.47±3.58)] were significantly higher in C group than in A and B group.  Age [(45.10±9.30)vs(51.40±7.80),(49.70±8.80)years], ΔI30/ΔG30 [(2.44±1.50)vs(8.27±6.33),(6.77±5.16)] and DI30 [(13.86±7.23)vs(58.21±18.14),(45.31±17.99)] were significantly lower (P<0.05). Spearson correlation analysis showed that HbA1c was positively correlated with HOMA-IR, but negatively correlated with HOMA-β, ΔI30/ΔG30, I/GAUC 60~120, DI30 and DI60~120. Multiple linear regression analysis showed that DI60~120, HOMA-IR, HOMA-β were the influencing factors for HbA1c.  Conclusion   With the increase of HbA1c, insulin secretion decreased gradually and IR increased constantly in patients with newly diagnosed T2DM, particularly in patients with HbA1c≥9.0%.
【Key words】Diabetes mellitus,type 2;Hemoglobin A1c (HbA1c); Pancreas islet function

上一篇:单纯性糖尿病肾脏损害的病理分型与国际标准的临床应用价值探讨 下一篇:2型糖尿病合并抑郁患者炎性因子和胰岛素抵抗指数的变化及其临床意义

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