2型糖尿病患者胰岛α细胞功能与肾小球滤过率的关系  

Relationship between islet α- cell function and glomerular filtration rate in type 2 diabetic patients

作　　者：王晓宇[1] 常宝成[1] 单春艳[1] 杨菊红[1] 徐延光[1] 郑妙艳[1] 王颖[1] 任惠珠[1] 赵然[1] 王珊珊[1] 陈莉明[1] 

机构地区：[1]天津医科大学代谢病医院糖尿病肾病科卫生部激素与发育重点实验室,300070

出　　处：《中华肾脏病杂志》2013年第8期583-588,共6页Chinese Journal of Nephrology

基　　金：国家自然科学基金（81273915,81072922）

摘　　要：目的分析不同估算肾小球滤过率（eGFR）水平的2型糖尿病患者胰岛d细胞功能。方法2型糖尿病患者388例，按照eGFR分为。肾小球高滤过组、肾功能正常组、肾功能轻度下降组及肾功能中重度下降组。行口服葡萄糖耐量试验及胰岛素（INS）、胰高血糖素（GLA）释放试验，比较各组间GLA、INS／GLA比值、血糖／GLA比值（GLU／GLA）、GLA曲线下面积（AUCGLA）等变化，并对GLA与eGFR等指标行相关性分析。结果随着eGFR下降，GLA水平变化曲线呈“J”字形；各组间空腹GLA水平分别为（82．21±15．06）ng／L、（74．25±15．34）ng／L、（81．16±20．18）ng／L、（100．21±24．73）ng／L，肾小球高滤过组及肾功能下降组餐后各时间点的GLA、AUCGLA均高于肾功能正常组（P〈0．05），INS／GLA、GLU／GLA均低于。肾功能正常组。Pearson相关分析显示，正常及肾功能下降组空腹GLA与eGFR（r=-0．360，P〈0．01）、血浆白蛋白（ALB）（r=-0．170，P〈0．01）、高密度脂蛋白胆固醇（HDL—C）（r=-0．128，P〈0．05）呈负相关；与空腹静脉血糖（FPG）（r=0．339，P〈0．01）、餐后2h静脉血糖（2hPG）（r=0．443，P〈0．01）、血糖曲线下面积（AUCG）（r=0．475，P〈0．01）、病程（r=0．257，P〈0．01）、糖化血红蛋白（HbA1c）（r=0．202，P〈0．01）呈正相关。多元逐步回归分析显示，正常及肾功能下降组空腹GLA与eGFR（β=-0．290，t=-5．393，P〈0．01）、HDL-C（β=-0．157，t=-3．026，P〈0．01）呈负相关。结论2型糖尿病患者GLA水平受eGFR影响。肾小球高滤过及肾功能下降患者的GLA水平明显高于肾功能正常患者。血糖及胰岛素对GLA的抑制作用均有减弱。Objective To analyze the islet α- cell function in type 2 diabetic patients with different levels of glomerular filtration rate（eGFR）. Methods Three hundred and eighty-eight cases of type 2 diabetic patients were classified into four groups according to eGFR： glomerular hyperfihration group, normal renal function group, mild renal dysfunction group and moderate- severe renal dysfunction group. Oral glucose tolerance test, insulin releasing test and glucagon releasing test were conducted to compare the changes of glucagon（GLA）, insulin/glucagon ratio （INS/GLA）, glucose/ glucagon ratio （GLU/GLA）, the area under the curve of glucagon（AUCGLA） among the groups and correlation analysis were performed among glucagon and glomerular filtration rate and other indicators. Results With the decline of eGFR, the change curve of glucagon level was ＂J＂ shaped： the level of fasting glucagon in each group were （ 82.21 ± 15.06 ） ng/L, （ 74.25 ± 15.34 ） ng/L, （ 81.16 ± 20.18 ） ng/L, （100.21 ± 24.73）ng/L, respectively. Compared with normal renal function group, GLA, AUCGLA in glomerular hyperfihration group and renal dysfunction group increased significantly（P 〈 0.05）, GLU/ GLA, INS/GLA decreased significantly. Pearson correlation coefficient analysis showed that fasting glucagon had a negative correlation with eGFR （r =-0.360, P 〈 0.01 ）, plasma albumin （ALB） （r = -0.170, P 〈 0.01 ） and high - density lipoprotein cholesterol （HDL - C） （r = -0.128, P 〈 0.05 ）, had a positive correlation with fasting venous blood glucose （FPG） （r = 0.339, P 〈 0.01）, postprandial 2 hours venous blood glucose（2hPG） （r = 0.443, P 〈 0.01 ）, the area under the cmwe of blood glucose （AUCG） （r = 0.475, P 〈 0.01 ）, duration （r = 0.257, P 〈 0.01 ） and glycosylated hemoglobin（HbAlc） （r= 0.202, P〈 0.01）. Multiple stepwise regression analysis showed that fasting glucagon was negatively correlated with eGFR （β = -0.290, t = -5.393, P �

关 键 词：胰高血糖素 糖尿病 2型 肾小球滤过率 胰岛Α细胞 

分 类 号：R587.1[医药卫生—内分泌]