2型糖尿病患者黎明现象与胰岛α和β细胞功能的关系  

Association between dawn phenomenon and islet α-cell andβ-cell function in patients with type 2 diabetes mellitus

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

机构地区：[1]天津医科大学代谢病医院内分泌研究所卫生部激素与发育重点实验室,300070

出　　处：《中华糖尿病杂志》2015年第6期367-371,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（T2DM）患者黎明现象与胰岛α和β细胞功能之间的关系。方法将2012年1月至2014年1月于天津医科大学代谢病医院行动态血糖监测、资料完整的218例T2DM患者按有无黎明现象分为2组，其中男102例，女116例，平均年龄（52±4）岁，检测两组生化指标，行口服葡萄糖耐量试验及胰岛素、胰高血糖素释放试验，比较两组空腹和糖负荷后胰岛α和β细胞功能变化。2组间比较采用t检验，对黎明现象行相关及回归性分析。结果黎明现象组糖化血红蛋白（HbA1c）、空腹血糖（FPG）与夜间最低点血糖净增值（BG1）、早餐后与早餐前血糖净增值（BG2）、24 h平均血糖（24 hMG）、稳态模型胰岛素抵抗指数（HOMA-IR）均高于无黎明现象组[分别为（8.3±2.2）%比（7.7±1.9）%、（1.41±0.33）比（0.96±0.26）mmol/L、（2.40±0.48）比（1.90±0.42）mmol/L、（10.7±2.2）比（9.4±1.8）mmol/L和4.3±0.9比3.4±0.8，t=2.1282-10.9955，均P〈0.05]。黎明现象组胰岛素敏感指数（ISI）低于无黎明现象组（t=2.1328，P〈0.05）。黎明现象组各时间点胰高血糖素水平、胰高血糖素/胰岛素比值、胰高血糖素/血糖比值及胰高血糖素曲线下面积（AUCG）明显高于无黎明现象组（t=2.0006-10.2190，均P〈0.05）。Logistic回归分析显示，黎明现象与HOMA-IR、胰高血糖素/胰岛素比值、BG2、BG1呈正相关，与ISI呈负相关（B=0.871、0.105、0.196、0.007、-0.519，均P〈0.05）。结论黎明现象与胰岛α和β细胞功能异常有关，改善胰岛功能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 dawn phenomenon and islet α-cell and β-cell function in patients with type 2 diabetes. Methods Two hundred and eighteen patients with type 2 diabetes who performed continuous glucose monitoring from January 2012 to January 2014 were divided into two groups： patients without dawn phenomenon and patients with dawn phenomenon. Biochemical indicators were detected in two groups. Oral glucose tolerance test, insulin releasing test and glucagon releasing test were performed to investigate the differences of α-cell andβ-cell function between groups after fasting and glucose-load. The correlation and regression analysis were performed between dawn phenomenon and other indicators. Results The level of HbA1c,the increment of fasting glucose and nocturnal nadir glucose（BG1）,the glucose increment before and after breakfast（BG2）,24 hours mean blood glucose（24 hMG） and HOMA-IR were significantly higher in patients with dawn phenomenon compared to those in patients without dawn phenomenon（（8.3%±2.2%） vs （7.7%±1.9%）, （1.41±0.33） vs （0.96±0.26）mmol/L, （2.40±0.48） vs （1.90±0.42）mmol/L,（10.69±2.25） vs （9.36±1.82）mmol/L,（4.3±0.9） vs （3.4±0.8）, t=2.1282, 10.9955,all P〈0.05）. Insulin sensitivity index（ISI） was lower in patients with dawn phenomenon than those in patients without dawn phenomenon（t=2.1328, P〈0.05）.The level of glucagon, glucagon/insulin ratio, glucagon/glucose ratio and area under curve of glucagon were significantly higher in patients with dawn phenomenon than those in patients without（t=2.000-10.2190,P〈0.05）. Logistic regression analysis showed that dawn phenomenon was positively related to HOMA-IR, glucagon/insulin ratio, BG2 and BG1（all P〈0.05）, and negatively related to ISI （P〈0.05）. Conclusions Dawn phenomenon is associated with the dysfunction of isletα-cell andβ-cell.Improving islet function may help to improve the dawn phenomenon and optimize glycemic control.

关 键 词：糖尿病 2型 黎明现象 胰岛Α细胞 胰岛Β细胞 

分 类 号：R587.1[医药卫生—内分泌]