2型糖尿病患者睡眠障碍与胰岛α和β细胞功能的关系  

Association between sleep disorder and islet α-cell and β-cell function in patients with type 2 diabetes mellitus

作　　者：任惠珠[1] 常宝成[1] 单春艳[1] 杨菊红[1] 郑妙艳[1] 王颖[1] 郭航[1] 孔岩[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：《中华糖尿病杂志》2014年第10期725-729,共5页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：国家自然科学基金（81173428、81373864）

摘　　要：目的 研究2型糖尿病患者睡眠障碍与胰岛α和β细胞功能之间的关系.方法 应用匹兹堡睡眠质量指数（PSQI）将2011年7月至2013年7月收治的440例2型糖尿病患者分为无睡眠障碍组和睡眠障碍组,检测两组血糖、糖化血红蛋白（HbA1c）,均行口服葡萄糖耐量试验及胰岛素、胰高糖素释放试验,比较两组间空腹和糖负荷后胰岛β细胞功能、胰高糖素和胰高糖素/胰岛素比值等的变化,对PSQI总分行相关及回归性分析.结果 睡眠障碍组糖化血红蛋白（HbA1c）为（8.6±2.4）％,空腹血糖为（8.5±2.1）mmol/L,空腹胰岛素为（14.4±4.4）mU/L,稳态模型胰岛素抵抗指数（HOMA-IR）为5.2±1.0,均高于无睡眠障碍组[分别为（7.5±1.9）％,（6.7±1.3）mmol/L,（12.9±4.6）mU/L和3.8±1.0]（t=5.358、11.085、3.578、14.448,均P＜0.05）.睡眠障碍组胰岛素敏感指数（ISI）为（-4.3±0.9）,低于无睡眠障碍组的（-4.0±0.6）（t=3.379,P＜0.05）.两组患者基础胰岛素和早时相胰岛素分泌无明显差异,睡眠障碍组胰岛素曲线下面积AUC1较无睡眠障碍组高（t=2.489,P＜0.05）.睡眠障碍组各时相胰高糖素水平、胰高糖素曲线下面积（AUCG）及胰高糖素/胰岛素比值明显高于无睡眠障碍组（t=2.047～ 8.131,P＜0.05）.多元逐步回归分析显示,PSQI总分与胰高糖素/胰岛素比值、HOMA-IR、年龄呈正相关（β值分别为0.244、0.281、0.307,均P＜0.05）,与ISI呈负相关（β=-0.105,P＜0.05）.结论 睡眠障碍与胰岛α和β细胞功能异常有关,改善睡眠障碍可能有助于改善“黎明现象”,从而优化血糖控制.Objective To investigate the association between sleep disorder and islet α-cell and β-cell function in patients with type 2 diabetes.Methods Four hundred and forty patients with type 2 diabetes treated from July 2011 to July 2013 were divided into two groups according to Pittsburgh Sleep Quality Index（PSQI）：patients without sleep disorder and patients with sleep disorder.The blood glucose and glycated hemoglobin A 1 c（HbA 1 c） was detected in the two groups.Oral glucose tolerance test（OGTT）,insulin releasing test and glucagon releasing test were performed to investigate the differences of the β-cell function,glucagon and glucagon/insulin ratio between groups after fasting and glucose-load.The correlation and regression analysis were performed between PSQI and other indicators.Results The level of HbA1c,fasting plasma glucose,fasting plasma insulin and HOMA-IR were significantly higher in patients with sleep disorder compared to those in patients without sleep disorder（8.6％±2.4％ vs 7.5％±1.9％,（8.5±2.1） vs （6.7±1.3） mmol/L,（14.4±4.4） vs （12.9±4.6） mU/L,5.2± 1.0 vs 3.8± 1.0,t=5.358,11.085,3.578,14.448,all P＜0.05）.Insulin sensitivity index（ISI） was lower in patients with sleep disorder than that in patients without sleep disorder（-4.3±0.9 vs-4.0±0.6,t=3.379,P＜0.05）.There was no significant differences in basal and early-phase insulin secretion between the two groups,while the insulin area under curve was higher in patients with sleep disorder than that in petients without（t=2.489,P＜0.05）.Blood glucagon,area under curve of glucagon and glucagon/insulin ratio were significantly higher in patients with sleep disorder than those in patients without（t=2.047-8.131,P＜0.05）.Multiple stepwise regression analysis showed that PSQI score was positively related to glucagon/insulin ratio,HOMA-IR and age（β =0.244,0.281,0.307,all P＜0.05）,and negatively related to ISI （β =-0.105,P＜0.05）.Conclusions Sleep disorder is associated with the dysfun

关 键 词：糖尿病 2型 睡眠障碍 胰岛Α细胞 胰岛Β细胞 

分 类 号：R587.1[医药卫生—内分泌]