初发2型糖尿病胰岛素强化治疗后胰岛β细胞功能变化  

Changes of islet β-cell function in newly diagnosed type 2 diabetes after intensive insulin treatment

作　　者：陈贵言[1] 高峰[1] 

机构地区：[1]华中科技大学附属协和医院内分泌科,湖北武汉430022

出　　处：《中国医院药学杂志》2008年第18期1529-1531,共3页Chinese Journal of Hospital Pharmacy

基　　金：国家教育部留学回国人员科研基金资助(编号:2005383)

摘　　要：目的:用精氨酸-C肽刺激试验(AST)观察胰岛素强化治疗(ⅡT)对初发2型糖尿病胰岛β细胞功能的影响以及CP峰值对选择治疗方案的指导价值。方法:50例新诊断的2型糖尿病患者(FPG>11.1mmol·L-1)在饮食运动治疗的基础上给予胰岛素强化治疗2个月,分析治疗前后空腹血糖(FPG)、餐后2h血糖(P2hPG)、糖化血红蛋白(HbA1-C)、空腹胰岛素(FINS)、胰岛素分泌指数(HOMA-IS)、胰岛素抵抗指数(HOMA-IR)、体质量指数(BMI)、三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)及AST0,2,3,4,5min时血糖(PG)及C肽(CP)分泌的变化。结果:胰岛素强化治疗后,FPG、P2hPG、HbA1-C、HOMA-IR、TG、TC、LDL-C较治疗前降低(P分别<0.01,<0.01,<0.01,<0.01,<0.01,<0.05,<0.05);HDL-C、HOMA-IS、FCP及精氨酸刺激后CP分泌较治疗前明显升高(P分别<0.05,<0.01,<0.05,<0.01);FINS及BMI与治疗前相比变化不大(P>0.05)。结论:胰岛素强化治疗通过改善初诊2型糖尿病的糖、脂毒性,能显著改善胰岛β细胞功能。精氨酸-C肽刺激试验安全、简便,可以反映胰岛β细胞的急性相分泌功能,对选择治疗方案具有一定的指导价值。OBJECTIVE To assess the changes of islet β-cell function by arginine stimulating test （AST） in newly diagnosed type 2 diabetic patients receiving the intensive insulin therapy （IIT） and to disclose the importance of CP peak value in optimi- zing the therapeutic regimen. METHODS 50 newly diagnosed type 2 diabetic patients with fasting plasma glucose （FPG）〉 11.1 mmol-L ＇ were given the intensive insulin therapy （IIT） for 2 months on the basis of diet control and exercise. At the en- try and 2 months after liT, FPG, P2hPG after taking Chinesce-bread meal test （equivalent to 75 g of glucose）, HbA1-C, fasting plasma insulin （FINS）, insulin secretary index （HOMA IS）, insulin resistant index （HOMA-IR）, body mass index （BMI）, total cholesterol （TC）, triglyceride （TG）, low density lipoprotein C （LDL-C） and high density lipoprotein-C （HDL- C） were measured. Meanwhile, the plasma glucose （PG） and C-peptide （CP） during the arginine stimulating test （AST） at 0, 2, 3, 4 and 5 minutes were detected before and 2 months after IIT. RESULTS After liT, FPG, P2hPG, HbA1 C, HOMA- IR, TG, TC and LDL-C were significantly lower than before （P〈0. 01, 〈0. 01, 〈0. 01, 〈0. 01, 〈0.01, 〈0. 05, 〈0. 05, respectively）, HDL-C, HOMA-IS, FCP and CP secretion after IIT increased significantly （P-〈0. 05, 〈0. 01, 〈0. 05, 0. 01, respectively）. Whereas, there were no significant change in FINS level and BMI after IIT （P〉0. 05）. CONCLUSION IIT can improve the islet β-cell function by reducing the glucotoxicity and lipotoxicity in newly diagnosed T2DM. AST is a sim- ple and effective method to the islet β-cell function. The peak value of CP after AST is helpful for us to choose the right regi men for T2DM.

关 键 词：胰岛Β细胞 精氨酸-C肽刺激试验 2型糖尿病 胰岛素强化治疗 

分 类 号：R977[医药卫生—药品]