2型糖尿病的不同阶段胰岛β细胞的早期分泌相变化  

Variations of β-cell early-phase insulin secretion in type 2 diabetic patients in different stages

作　　者：钟惠菊[1] 王敏[2] 廖岚[1] 陈慧玲[1] 郭丽娟[1] 

机构地区：[1]中南大学湘雅医院内分泌科,长沙410008 [2]中南大学湘雅二医院内分泌科,长沙410011

出　　处：《中南大学学报（医学版）》2006年第2期232-235,共4页Journal of Central South University ：Medical Science

摘　　要：目的:探讨2型糖尿病的不同阶段患者胰岛β细胞早期分泌相的变化规律。方法:对4 0例正常对照者和1 0 1例2型糖尿病患者行精氨酸(L-ARG)兴奋试验并检测空腹血糖和体质量指数等参数。2型糖尿病患者分为3组:初发组3 5例、磺脲类药物治疗有效组3 2例和继发性磺脲类药物治疗失效组3 4例。计算L-ARG兴奋试验中的急性胰岛素反应(acute insu lin response,AIRARG)指数、稳态模型评价的胰岛素抵抗指数(insu lin resistance of hom eostasis model assessm ent,HOMA-IR)及其胰岛素分泌指数(in-su lin secretion of hom eostasis model assessm ent,HOMA-IS),各组间进行统计学比较。结果:2型糖尿病各组的HOMA-IR较对照组显著升高(P<0.0 1);校正胰岛素抵抗对胰岛素分泌值评估胰岛功能的影响后,2型糖尿病各组患者的AIRARG指数较对照组显著下降(P<0.0 1),2型糖尿病各组间AIRARG指数比较为:初发组>有效组>失效组(P<0.0 1);2型糖尿病各组间的HOMA-IS比较未发现初发组和有效组间差异有统计学意义(P>0.0 5)。结论:2型糖尿病各个阶段均存在严重的胰岛素抵抗,从初发者到继发性磺脲类失效患者,其胰岛β细胞早期分泌相的改变表现为逐级衰退的动态变化过程。Objective To explore the variations of early-phase insulin secretion in Type 2 diabetic patients in different stages. Methods L-arginine stimulative test, fast blood glucose and body mass index （ BMI ） were evaluated in 40 nomal controls （ NC ） and 101 Type 2 diabetic patients. The diabetic patients were divided into three groups：newly by sulfonylureas group （n = 32 ） , and secondary fail dexs of insulin resistance of homeostasis model assessment （ HOMA-IR ） , β-cell insulin secretion of homeostasis model assessment （HOMA-IS）, and the acute insulin response （AIRARG ） index were calculated. Some statistical comparisons were done among the 4 groups. Results The indexs of HOMA-IR in each group of Type 2 diabetic patients were all higher than those in NC group （P 〈 0.01 ）. The AIRARG indexs were obviously lower in Type 2 diabetic patients in different stages than those in NC group （ P 〈 0. 01 ） , and the subsequence from the highest to the lowest among the groups of diabetic patients was： the newly diagnosed group, the effectively treated by sulfonylureas group, and the secondary failure of sulfonylureas group （ P 〈 0. 01 ）. But there was no signific difference in indexs of HOMA-IS between the newly diagnosed group and the effectively treated sulfonylureas group. Conclusion There is severe insulin resistance in Type 2 diabetic patients ant by in each stage. The variations of early-phase insulin secretion manifest a vary procedure of obvious deterioration by degrees from the newly diagnosed group to the secondary failure of sulfonylureas group in Type 2 diabetic patients.

关 键 词：2型糖尿病 Β细胞功能 继发性磺脲类失效 左旋精氨酸 

分 类 号：R587.1[医药卫生—内分泌]