精氨酸刺激试验在不同糖代谢状态人群的临床应用  

Clinical application of arginine stimulation test in estimating islet β cell function in individuals with different abnormalities of glucose metabolism

作　　者：马晓静[1] 吴松华[1] 项坤三[1] 陆俊茜[1] 陆蔚[1] 丁虹[1] 

机构地区：[1]上海市糖尿病研究所上海交通大学附属第六人民医院内分泌代谢科,200233

出　　处：《中华内分泌代谢杂志》2005年第3期215-218,共4页Chinese Journal of Endocrinology and Metabolism

摘　　要：目的探讨精氨酸刺激试验能否用于评价胰岛β细胞储备功能及其判断标准。方法分别检测225人空腹及盐酸精氨酸刺激后2、4、6 min时血糖(PG)、真胰岛素(TI)、C肽(CP)水平的变化,其中正常糖耐量组(NGT)39名、糖耐量受损组(IGT)29例、1型糖尿病组(T1DM)11例,新诊断2型糖尿病组(NT2DM)43例和原诊断2型糖尿病组(PT2DM)103例。结果(1)NGT组空腹TI/PG显著高于IGT组(P<0.05),但两组的空腹CP/PG差异无统计学意义(P>0.05)。空腹CP/PG在T1DM、NT2DM、PT2DM组显著低于NGT、IGT组(均P<0.01),并且PT2DM组显著低于NT2DM组(P<0.01)。(2)精氨酸刺激后T1DM组无快速TI、CP分泌。其余各组在刺激后TI/PG、CP/PG除IGT组与NGT组差异无统计学意义(P>0.05)外,NT2DM、TP2DM组均显著低于NGT、IGT组(均P<0.01),并且2 min时PT2DM组亦显著低于NT2DM组(均P<0.01)。(3)精氨酸刺激后TI/PG、CP/PG的增值及曲线下面积在NGT、NT2DM、PT2DM三组间差异有统计学意义(均P<0.01)。结论(1)精氨酸刺激试验可用于判别和评估不同糖代谢状态人群胰岛β细胞功能,尤其是DM人群β细胞功能的判别。(2)精氨酸刺激后TI/PG值及其峰值/空腹值、TI/PG的增值和曲线下面积均可能作为评价β细胞功能异常的指标,其中以TI/PG的增值和曲线下面积为佳。Objective To investigate the possibility of the arginine stimulation test to estimate islet βcell function in individuals with different abnormalities of glucose metabolism. Methods Serum blood glucose (PG), true insulin (TI) and C-peptide (CP) were measured at 0, 2, 4 and 6 minutes after arginine stimulation in 225 individuals, including 39 with normal glucose tolerance(NGT), 29 with impaired glucose tolerance (IGT), 11 with type 1 diabetes (T1DM),43 with newly diagnosed type 2 diabetes (NT2DM) and 103 with previously diagnosed type 2 diabetes (PT2DM). Results (1) The fasting values of TI/PG in NGT were higher than others (P<0.05). The difference in the fasting values of CP/PG between IGT and NGT showed no statistical significance (P>0.05). The fasting values of CP/PG were lower in T1DM, NT2DM and PT2DM than NGT and IGT (all P<0.01), and that in PT2DM were lower than NT2DM (P<0.01). (2) After arginine stimulation TI secretion in T1DM was nearly or totally absent. The differences in TI/PG and CP/PG after arginine stimulation between IGT and NGT showed no statistical significance (P>0.05). The values were lower in T1DM, NT2DM and PT2DM than those in NGT and IGT (P<0.01). (3) The differences in the values of ΔTI/PG, ΔCP/PG, AUC[TI/PG] and AUC[CP/PG]amongNGT,NT2DMandPT2DM had statistical significance (all P<0.01). Conclusion (1) By utilizing acute insulin secretion phase, the arginine stimulation test is in a position to estimate β cell secretory capacity in individuals with different abnormalities of glucose metabolism especially in DM individuals. (2) The TI/PG, ΔTI/PG and AUC [TI/PG] values after arginine stimulation may be used as predictors for islet β cell function in clinical practice, of which ΔTI/PG and AUC [TI/PG] parameters appear to be more valuable.

关 键 词：精氨酸刺激试验 糖代谢 临床应用 胰岛Β细胞 糖尿病 

分 类 号：R587.1[医药卫生—内分泌]