初发2型糖尿病胰岛素C肽释放特点及相关因素分析  

Characteristics and relevant factors of insulin,C-peptide release after oral glucose tolerance test in newly diagnosed type 2diabetes mellitus

作　　者：谢媛[1] 马向华[1] 倪娟[1] 桑谊荃[1] 李晓娜[1] 俞岭[1] 

机构地区：[1]南京医科大学第一附属医院江苏省人民医院内分泌科,江苏南京210029

出　　处：《临床荟萃》2013年第4期368-371,376,共5页Clinical Focus

摘　　要：目的探讨初发2型糖尿病患者口服葡萄糖耐量实验和胰岛素、C肽变化特点及相关因素。方法初发2型糖尿病患者192例,口服75g葡萄糖耐量试验和胰岛素、C肽释放试验,分别在0、30、60、120、180分钟测定血糖、胰岛素和C肽。根据胰岛素和C肽高峰出现时间分为胰岛素C肽分泌高峰同步组和胰岛素C肽分泌高峰不同步组,使用稳态模型评估胰岛素抵抗程度、胰岛β细胞功能、Matsuda胰岛素敏感指数(Matsuda insulin sensitive index,Matsuda ISI)评估胰岛素敏感性。结果胰岛素C肽分泌高峰比较,同步组与不同步组C肽高峰均在120分钟,不同步组胰岛素高峰在60分钟,同步组在120分钟;同步组120分钟胰岛素、C肽(35.54±28.98)mU/L、(2317.02±973.21)pmol/L,高于不同步组(24.72±20.88)mU/L、(1956.93±657.22)pmol/L;同步组C肽曲线下面积(3.15×105±1.21×105)pmol×min高于不同步组(2.82×105±8.62×104)pmol×min。结论初发2型糖尿病行口服葡萄糖耐量实验和胰岛素、C肽释放实验显示,胰岛素、C肽释放高峰同步的患者实际胰岛素抵抗程度要高于不同步组,当两者不同步时,C肽释放试验更能反映2型糖尿病的真实病理生理状态。Objective To discuss the characteristics and relevant factors of glucose,insulin and C-peptide release after oral glucose tolerance test in newly diagnosed type 2 diabetes mellitus. Methods The study involved a total of 192 newly diagnosed type 2 diabetes patients. Venous blood was sampled at 0 min, 30 rain, 60 min, 120 min, 180 min of 75 g oral glucose tolerance test to measure glucose,insulin and C peptide. All patients were divided into two groups： insulin and C-peptide peak time cogradient group and non cogradient group according to the peak time of insulin and C-peptide in releasing test. Results Patients in both cogradient group and non-cogradient group had a C-peptide peak time at 120 min. Patients in cogradient group had an insulin peak time at 60 min,while in non-cogradient group at 120 min. 120 min insulin and C-peptide concentration was higher in cogradient group（35.54± 28.98 ）mU/L, （2 317.02± 973.21 ） pmol/L than non-cogradient group （24.72 ± 20.88） mU/L, （1 956.93± 657.22） pmol/L. The area under the curve of C- peptide was lager in cogradient group （3.15 ×105±1.21×105） pmoiX min compared with non-cogradient group （2.82×105±8.62×104 ） pmol X min. Conclusion Insulin-resistance is more serious in newly diagnosed type 2 diabetes patients who have a cogradient insulin and C-peptide peak time. C-peptide releasing test is better to show the real state in type 2 diabetes patients when peak time of insulin and C-peptide in releasing test are not cogradient.

关 键 词：糖尿病 2型 葡糖耐量试验 胰岛素抵抗 

分 类 号：R587.1[医药卫生—内分泌]