精氨酸刺激试验评估胰岛β细胞功能的临床价值  

Application of arginine stimulation test in evaluating function of pancreatic islet beta cell

作　　者：刘湘茹[1] 杨斌[2] 胡德龙[1] 

机构地区：[1]广东省佛山市顺德第一人民医院内三科,528300 [2]广东省佛山市顺德第一人民医院内五科,528300

出　　处：《中国医师进修杂志》2010年第19期9-12,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的 研究精氨酸刺激试验评估糖尿病患者胰岛β细胞功能的价值.方法 21例Ⅰ型糖尿病患者（DM1组）及113例2型糖尿病患者（DM2组）[分为DM2a组（病程≤1年）58例和DM2b组（病程〉1年）55例两个亚组]分别行精氨酸刺激试验,测定空腹及注射精氨酸后2、3、4、5min C肽水平,评估胰岛β细胞功能及临床治疗的符合率.结果 DM1组精氨酸刺激后C肽与空腹C肽比较差异无统计学意义（P〉0.05）,DM2组精氨酸刺激后C肽于3 min达高峰,与空腹C肽比较差异有统计学意义（P〈0.01）;空腹C肽、精氨酸刺激后C肽水平DM2a组〉DM2b组〉DM1组;DM1组3 min C肽均〈600 pmol/L,全部需胰岛素治疗,符合率为100.0%,DM2组3 min C肽≥600pmol/L者可饮食控制或口服降糖药治疗的符合率为93.4%（85/91）,3minC肽〈600pmol/L者需胰岛素治疗的符合率为86.4%（19/22）.结论 精氨酸刺激试验是一种简单可行、方便、安全性好的评估糖尿病患者胰岛β细胞功能的方法.建议今后临床可考虑以精氨酸刺激试验3 min C肽水平作为鉴别Ⅰ型及2型糖尿病,并以是否≥600 pmol/L作为2型糖尿病指导治疗的参考.Objective To investigate the value of intravenous arginine stimulation test （AST） in evaluating function of pancreatic islet beta cell response in patients of diabetes mellitus. Methods Twentyone patients with type 1 diabetes mellitus （DM1, DM1 group） and 113 patients with type 2 diabetes mellitus （DM2, DM2 group） were recruited in this study. DM2 patients were divided into two sub-groups, DM2a group （duration of no more than 1 year, 58 patients） and DM2b group （more than 1 year, 55 patients）. The serum levels of C-peptide （CP） were determined at fasting and 2,3,4,5 minutes after intravenous injection of 5 g arginine. Results In DM1 group, the level of CP after injection of arginine was. similar to the fasting level （P〉 0.05 ）. In DM2 group, the peak level of CP appeared at 3th minute （CP3） during AST, and was significantly higher than fasting CP level（P 〈 0.01 ）. The level of fasting and arginine-stimulated CP in DM2a group was significantly higher than that in DM2b group, and the level of fasting and arginine-stimulated CP in DM2b group was significantly higher than that in DM1 group. The patients of DM1 group whose level of CP3 〈 600 pmol/L all needed insulin injection to control hyperglycemia, and the coincident rate was 100.0%.In DM2 group, there were 91 patients whose CP3 ≥600 pmol/L, among which 85 patients could be well controlled with diet or oral hypoglycemic agents, and the coincidentrate was 93.4%; there were 22 patients whose CP3 〈 600 pmol/L, among which 19 patients need insulin injection to control hyperglycemia, and the coincident rate was 86.4%. Conclusions AST is valuable in assessing the function of pancreatic islet beta cell in patients with diabetes mellitus. The level of CP3 ≥600 pmol/L can be considered as a reference in diagnosis and treatment of diabetes mellitus.

关 键 词：C肽 胰岛素分泌细胞 糖尿病 精氨酸刺激试验 

分 类 号：R587.1[医药卫生—内分泌]