2型糖尿病患者糖化血红蛋白水平与胰岛素分泌及胰岛素抵抗的关系  

Correlation between Insulin Secretion,Insulin Resistance and Glycosylated Hemoglobin Levels in Patients with Type 2 Diabetic

作　　者：张曙晴 李洪彬[2] 张骆军 王峥骅 

机构地区：[1]南通市第二人民医院检验科,江苏南通226002 [2]南通市第二人民医院内分泌科,江苏南通226002

出　　处：《现代检验医学杂志》2016年第2期108-111,共4页Journal of Modern Laboratory Medicine

摘　　要：目的比较不同糖化血红蛋白（HbAlc）水平的2型糖尿病（T2DM）患者胰岛素分泌和胰岛素抵抗情况，了解葡萄糖毒性对胰岛口细胞分泌功能的影响。方法将137例T2DM患者，按HbAlc水平分为4组，即A组（HbAlc≤70），B组（7％〈HbAlc≤9％），C组（9％〈HbAlc≤11％）和D组（HbAlc〉11％），测定各组空腹血糖（FPG），HbAlc及精氨酸刺激前后各时点的胰岛素（INS）。用稳态模型评估法评价基础胰岛素分泌功能（HOMA-β）和胰岛素抵抗指数（HOMA-IR），并用精氨酸刺激后血糖校正胰岛素增值（△INS／FPG）评估第一相胰岛素分泌功能。结果各组T2DM患者FPG差异均有统计学意义（F=15．633～106．154，P值均〈0．01），且与HbAlc呈正相关（r=0．627，P〈0．01）；HOMA—β和△INS／FPG均表现为A组、B组分别与其他各组差异有统计学意义（F=4．106～16．255，P值均〈0．05），但c组与D组之间差异无统计学意义（F=0．761，2．756，P值均〉0．05）；A组HOMA-IR与C组、D组之间差异有统计学意义（F=4．836，8．524，P值均〈0．05）；精氨酸刺激后胰岛素分泌不足检出率在HbAlc〉9％时明显升高。结论胰岛B细胞功能的判断受长期糖毒性的干扰，故将T2DM患者的HbAlc控制在9%以下进行胰岛素分泌功能评估及精氨酸刺激试验，能较为准确地反映胰岛p细胞功能。Objective To compare insulin secretion and Insulin resistance of type 2 diabetic patients with different HbAlc levels,and to evaluate the effect of glucose toxicity on the islet β cell response. Methods 137 cases type 2 diabetes mellitus （T2DM） patients were divided into 4 groups according to HbAlc levels：group A with HbAlc≤7% ,group B with 7% HbAlc≤9 %, group C with 9 % 〈 HbA1 c≤ 11 % and group D with HbA1 c〉 11%. Detected fasting blood glucose （FPG）, HbAlc and each time point of insulin （INS） after arginine stimulation. Homeostasis model assessment was used to evaluate basal insulin secretion （HOMA-β） and insulin resistance （HOMA-IR）. The incremental value of insulin by blood glucose corrected （AINS/FPG） after arginine stimulation was used to evaluate the first phase insulin secretion. Results The level of FPG had significant differencein each group of T2DM patients （F= 15. 633- 106. 154, P〈0.01）, and was positively correlated with HbAlc （r=0. 627,P〈0.01）. The level of HOMA-β and △INS/FPG were showed that group A and B were statistical significant difference with the other groups （F= 4. 106 - 16.255, P〈0.05）, but the difference was not statistical significant between group C and group D （F=0. 761,2. 756 ,P）0.05）. The level of HOMA-IR in group A was statistical significant comparing group C and group D （F= 4. 836,8. 524, P〈0.05）. After arginine stimulation, the detection rate of the decreased function of insulin secretion increased significantly with HbAlc 〉9 %. Conclusion The measurement of islet cell＇s function was influenced by long-term high glucose toxicity. Therefore, patients with T2DM, which the level of H bAlc was less than 9 %, were conducted with insulin secretion function evaluation and arginine stimulation test, this could reflect the function of islet βcell more accurately.

关 键 词：2型糖尿病 葡萄糖毒性 胰岛素分泌 胰岛素抵抗 糖化血红蛋白 

分 类 号：R587.1[医药卫生—内分泌] R446.112[医药卫生—内科学]