精氨酸刺激试验中不同时间点胰岛素/血糖增值对2型糖尿病患者胰岛β细胞功能的评价作用  

The net increment of insulin/glucose at different time points of arginine stimulation test for assessment of islet β cell function in patients with type 2 diabetes mellitus

作　　者：王军[1] 常薪霞[1] 张林杉 夏明锋[1] 颜红梅[1] 卞华[1] 高键[2,3] 高鑫[1] 

机构地区：[1]山东齐河县人民医院内科 [2]复旦大学附属中山医院内分泌科,上海200032 [3]复旦大学附属中山医院营养科,上海200032

出　　处：《复旦学报（医学版）》2014年第6期798-802,共5页Fudan University Journal of Medical Sciences

基　　金：卫生部重点专科建设基金;985Ⅲ期教育部医学学科建设项目(985 Ⅲ YFX0302);国家自然科学基金青年项目(81100602)~~

摘　　要：目的了解精氨酸刺激试验中不同时间点胰岛素/血糖增值对2型糖尿病(type 2diabetes mellitus,T2DM)患者胰岛β细胞储备功能的评价作用,以探讨精氨酸刺激试验的简易方法。方法 2009年9月至2013年1月复旦大学附属中山医院内分泌科收治的1730例T2DM患者,在精氨酸刺激后2、4、6min分别采血测血糖(serum glucose,G)、真胰岛素(insulin,S)和C肽(C-peptide,CP)。胰岛素/血糖的增值(ΔIS/G)作为评价胰岛β细胞功能的标准,采用相关性分析比较精氨酸刺激后2 min、4 min及6 min胰岛素/血糖的增值(Δ2IS/G、Δ4IS/G、Δ6IS/G)与胰岛β细胞功能相关性;进一步采用Bland-Altman方法评价不同时间点ΔIS/G与精氨酸刺激后ΔIS/G增值的一致性。结果 T2DM患者中精氨酸刺激后每一时间点均与ΔIS/G呈显著相关(Δ2IS/G:r=0.889,P<0.01;Δ4IS/G:r=0.973,P<0.01;Δ6IS/G:r=0.903,P<0.01),其中精氨酸刺激后Δ4IS/G与精氨酸刺激后ΔIS/G相关性最强。Bland-Altman分析结果表明精氨酸刺激后Δ2IS/G、Δ4IS/G及Δ6IS/G与平均ΔIS/G一致性高,且以Δ4IS/G最佳。结论可以用精氨酸刺激后Δ4IS/G来评价T2DM胰岛β细胞的第一相胰岛素储备功能。Objective To investigate the net increment of insulin/glucose （AIS/G） at different time points during arginine stimulation test for the function assessment of islet β cells in patients with type 2 diabetes mellitus （T2DM）, so as to explore a simple method of arginine stimulation test. Methods Serum glucose （G） ,insulin （IS） and C-peptide （CP） were measured at 2,4 and 6 minutes after arginine stimulation in 1 730 patients with T2DM collected by Zhongshan hospital from Sept. , 2013 to Jan. , 2{）14. The function of islet ~ cells was judged by the average AIS/G after arginine stimulation. Pearson＇ s correlation was used to analyze the relation of the average AIS/G,and the AIS/G at 2 minutes （A2IS/ G） ,4 minutes （A4IS/G） and 6 minutes （A6IS/G） after arginine stimulation. Bland-Altman analysis was performed to analyze the consistency of these different indexes. Results The AIS/G at each time point during arginine stimulation （A2IS/G,A4IS/G and A6IS/G） was significantly associated with the average AIS/G （A2IS/G：r = 0. 889, P〈0. 01 ;A4IS/G： r = 0 973,P〈0. 01;A61S/G： r = 0.903,P〈 0. 01 ）. Furthermore,the most significant correlation was observed between A4IS/G and AIS/G. Bland- Altman analysis showed that A2IS/G, A4IS/G and A6IS/G was highly consistent with the average ＆IS/ G,among which A4IS/G was the most suitable for alternative index. Conclusions The A4IS/G in the arginine stimulation test could he used as reliable parameters in evaluating the early phase insulin secretion of β cells in patients with T2DM.

关 键 词：2型糖尿病(T2DM) 精氨酸刺激试验 胰岛Β细胞 

分 类 号：R587.1[医药卫生—内分泌]