2型糖尿病和糖调节受损患者在葡萄糖负荷时血浆Ghrelin水平的变化及其与胰岛素的关系  

Changes of plasma ghrelin concentrations during OGTT in patients with IGR and type 2 diabetes mellitus

作　　者：高燕明[1] 卢桂芝[1] 董爱梅[1] 陈宇[1] 杨建梅[1] 蔡大勇[2] 庞永正[2] 唐朝枢[2] 

机构地区：[1]北京大学第一医院内分泌科,100034 [2]北京大学第一医院心血管病研究所,100034

出　　处：《中华糖尿病杂志（1006-6187）》2004年第5期352-355,共4页

摘　　要：目的　研究 2型糖尿病 (T2DM)、糖调节受损 (IGR)患者血浆Ghrelin对葡萄糖负荷的反应及其与胰岛素 (Ins)的关系。　方法　选择年龄、性别、腰围、BMI相匹配的T2DM患者 33例、IGR 14例及正常葡萄糖耐量者 (NC) 11例行口服葡萄糖耐量试验 ,同步取血测定血浆Ghrelin及Ins。以HOMA公式评价Ins分泌及抵抗情况。　结果　 (1)T2DM组、IGR组与NC组 (正常体重、肥胖者及BMI相匹配者 )之间空腹及葡萄糖负荷后血浆Ghrelin水平及其曲线下面积 (AUC)差异均无显著意义 (P均 >0 0 5 )。 (2 )T2DM服药组 (14例 )血浆 6 0minGhrelin值及Ghrelin AUC均显著低于未用药组 (19例 ) [6 0min :(32± 5 )pg/ml对 (5 1± 16 ) pg/ml,P <0 0 5 ;AUC(71± 10 ) pg/ml对 (114± 36 )pg/ml,P均 <0 0 5 ]。 (3)空腹血浆Ghrelin在有血管并发症T2DM组 (18例 )明显低于NC组 [(4 2±6 ) pg/ml对 (72± 17)pg/ml,P <0 0 5 ],其HOMA IR明显高于NC组 (P <0 0 5 )。 (4 )Ghrelin AUC与Ins AUC呈独立负相关 (r=- 0 5 97,P =0 0 4 0 )。 (5 )T2DM组 12 0minGhrelin水平与糖化血红蛋白 (HbA1c)呈独立相关 (r =0 718,P =0 0 0 1)。　结论　 (1)伴有血管并发症的T2DM患者血浆Ghrelin水平明显低于NC组 ,且其HOMA IR明显高于后者 。Objective To investigate the responses of plas ma ghrelin to the oral glucose loading in patients with IGR and type 2 diabetes mellitus(T2DM). Methods Circulating ghrelin and insulin level s were measured during OGTT in 14 cases with IGR, 33 cases with T2DM and 11 cas es with normal glucose tolerance (NGT). They were compared among the 3 grou ps which were matched at age, sex, waist circumference and BMI. Oral glucose -induced insulin release were performed in all subjects. Insulin sensitivity w as assessed by homeostasis model assessment (HOMA). Results ( 1) There was no significant difference in plasma Ghrelin concentration at fast a nd during OGTT and in its area under curve(AUC) among 3 groups of IGR,NGT and T 2DM. (2) Plasma ghrelin level at 60 min after glucose load and ghrelin -AUC in type 2 diabetics with oral hypoglycemic agents (n=14)were lower than t hose without oral drugs(n=19)(60 min:32±5 and 51±16 pg/ml,P<0.0 5;AUC 71±10 and 114±36 pg/ml,P<0.05).(3) Plasma ghrelin concentratio ns were obviously lower in T2DM with vascular complications (n=18)than in control group with normal-weight(42.20±6.07and 72.20±57.26 pg/ml,P <0.05),but their HOMA-IR were obviously higher than the latter(P<0. 05). (4) Ghrelin -AUC in these three groups were negatively correlated with i nsulin-AUC(r=-0.597,P=0.040)independently.(5) Plasma ghrelin level a t 120 min was positively correlated with HbA 1c(r=0.718, P=0.001)indepe ndently. Conclusions These data suggest:(1)Insulin resistan ce in diabetics with angiopathy might affect circulating ghrelin concentration .(2) HbA 1c is positively correlated with plasma ghrelin level at 120 min i ndependently.

关 键 词：血浆 T2DM 患者 糖负荷 糖调节受损 胰岛素 血管并发症 HbA1c AUC 药组 

分 类 号：R587.1[医药卫生—内分泌]