不同HbA1C水平2型糖尿病患者药物干预胰岛α及β细胞功能评价  

Evaluation of islet α-cell and β-cell function at different levels of HbAlc in patients with type 2 diabetes mellitus

作　　者：郭航[1] 常宝成[1] 杨菊红[1] 单春艳[1] 郑妙艳[1] 刘婕妤[1] 孔岩[1] 陈莉明[1] 

机构地区：[1]天津医科大学代谢病医院,卫生部及天津市激素与发育重点实验室,300070

出　　处：《中华内分泌代谢杂志》2013年第4期273-277,共5页Chinese Journal of Endocrinology and Metabolism

基　　金：天津市自然科学基金（IOJCYBJC13200）;天津市卫生局科技基金（2010KZ88）

摘　　要：目的 了解不同HbA1C水平2型糖尿病患者胰岛α、β细胞功能状况。方法 2型糖尿病患者288例，按HbA1C水平分为4组：A组：HbA1C≤7.0％；B组：7.0％＜HbA1C≤9.0％；C组：9.0％＜HbA1C≤11.0％；D组：HbA1C＞11.0％。联合进行口服葡萄糖耐量试验及胰岛素、胰升糖素释放试验，比较各组间胰升糖素、胰升糖素/胰岛素比值、早时相胰岛素分泌指数（ΔI30/ΔG30）、第二时相胰岛素分泌（以胰岛素曲线下面积评价）等的变化，并对胰升糖素与胰岛β细胞功能、HbA1C等指标行相关性分析。结果 （1）随HbA1C升高，空腹及餐后各时相胰升糖素、胰升糖素/胰岛素比值及胰升糖素曲线下面积均明显升高（均P＜0.05）。（2）与HbA1C≤7.0％的A组比较，HbA1C＞7.0％的B、C、D组评价胰岛素抵抗的稳态模型评估的胰岛素抵抗指数（HOMA-IR）明显升高，评价胰岛素敏感性的胰岛素敏感指数及评价胰岛分泌功能的稳态模型评估的胰岛β细胞功能指数（HOMA-β）、ΔI30/ΔG30及胰岛素曲线下面积均明显下降，差异有统计学意义（均P＜0.05），以ΔI30/ΔG30最明显，4组ΔI30/ΔG30自然对数值依次为（1.0 ± 0.15）、（0.5 ± 0.07）、（0.4 ± 0.05）、（0.1 ± 0.03）。（3）胰升糖素与ΔI30/ΔG30、HOMA-β、体重指数、胰岛素敏感指数及胰岛素曲线下面积呈负相关（均P＜0.05），与空腹血糖、葡萄糖曲线下面积、HOMA-IR、HbA1C及病程呈正相关（均P＜0.05）。结论 2型糖尿病患者存在胰岛α、β细胞功能的异常,特别是对于HbA1C水平过高的患者，关注胰升糖素的调控可能更容易使血糖达标。Objective To investigate the change of islet α-cell and β-cell function at different levels of HbA1C in patients with type 2 diabetes mellitus. Methods A total of 288 cases of type 2 diabetic patients were divided into four groups according to their HbA1C levels： HbA1C≤7.0%（Group A）, 7.0%〈HbA1C≤9.0%（Group B）, 9.0%〈HbA1C≤11.0%（Group C）, and HbA1C〉11.0%（Group D）. Oral glucose tolerance test, insulin releasing test, and glucagon releasing test were performed to observe the differences in glucagon, glucagon/insulin, early insulin secretion index（ΔI30/ΔG30）, and the second-phase insulin secretion index [using area under curve of insulin（AUCI） ] among the four groups, and a correlation analysis was performed between glucagon and other indicators. Result （1）Glucagon, glucagon/insulin, and area under curve of glucagon increased significantly with the increase of HbA1C（all P〈0.05）.（2） Compared with group A, homeostasis model assessment for insulin resistance（HOMA-IR） in group B, C, and D were significantly higher（P〈0.05）, insulin sensitivity index, homeostasis model assessment for β cell function（HOMA-β）, ΔI30/ΔG30, the AUCI were significantly lower（all P〈0.05）. Compared with group A, ΔI30/ΔG30 in group B and C dropped about 50%（P〈0.05）, and ΔI30/ΔG30 in group D decreased 90%（P〈0.05）.（3） Person correlation analysis showed that glucagon had a negative correlation with ΔI30/ΔG30, HOMA-β, body mass index, insulin sensitivity index, AUCI（all P〈0.05）, and a positive correlation with fasting plasma glucose, area under curve of glucose, HOMA-IR, HbA1C, course of diabetes（all P〈0.05）. Conclusions Abnormal function of islet α-cell and β-cell exist in patients with type 2 diabetes, especially in those with higher levels of HbA1C, indicating that regulation of glucagon will make the blood glucose target be reached more easily.

关 键 词：胰升糖素 胰岛Α细胞 胰岛β细胞 HBALC 糖尿病 2型 

分 类 号：R587.1[医药卫生—内分泌]