精氨酸刺激试验评估胰岛β细胞1相分泌功能的价值及对2型糖尿病治疗的指导作用  

The value of arginine stimulation test in evaluating the first-phase insulin secretion and its guiding role for the treatment of type 2 diabetes mellitus

作　　者：朱小鹏 颜红梅[1,2] 常薪霞 夏明锋[1,2] 王柳 卞华[1,2] 高鑫 

机构地区：[1]复旦大学附属中山医院内分泌科,上海200032 [2]复旦大学代谢性疾病研究所,上海200032

出　　处：《中国临床医学》2017年第4期548-553,共6页Chinese Journal of Clinical Medicine

基　　金：国家自然科学基金面上项目(81471073);上海市科委项目(13441900303);复旦大学附属中山医院优秀骨干计划(2015ZSYXGG15)~~

摘　　要：目的:探讨精氨酸刺激试验评估胰岛β细胞1相分泌功能的价值及其对2型糖尿病治疗的指导作用。方法:选择复旦大学附属中山医院内分泌科及体检中心诊治的新诊断2型糖尿病(NT2DM) 80例,饮食运动或口服降糖药物治疗有效(LIODT) 62例,胰岛素治疗(IT) 160例和正常对照(NC) 40例。采用精氨酸刺激试验评估β细胞1相分泌功能,测定空腹0 min与精氨酸刺激后2、4、6 min时血糖(G)、胰岛素(I)和C肽(CP)水平。结果:与NC组相比,NT2DM组、LIODT组、IT组精氨酸刺激试验中ΔI、ΔI/G和ΔCP/G明显降低(P<0.01)。不同阶段2型糖尿病中,IT组ΔI、ΔCP、ΔI/G、ΔCP/G较NT2DM组、LIODT组明显降低(P<0.01)。AIR正常截点为ΔI≥23.09 mU/L。校正了性别、年龄、体质指数(BMI)后,ΔI、ΔI/G、ΔCP/G与空腹血糖(FPG)及HbA1c负相关,ΔI、ΔCP、ΔI/G、ΔCP/G与每日口服降糖药种类及口服降糖药剂量负相关。在已诊断2型糖尿病中(包括LIODT组、IT组),ΔI、ΔCP评判需要使用胰岛素治疗2型糖尿病的最佳临界值分别为12.23 mU/L、0.97 ng/mL(P<0.01)。结论:精氨酸刺激试验可有效评估胰岛β细胞1相分泌功能,2型糖尿病患者达到功能临界值(ΔI≤12.23 mU/L,ΔCP≤0.97 ng/mL)时需行胰岛素治疗。Objective：To explore the value of arginine stimulation test in evaluating the first-phase insulin secretion and its guiding role for the treatment of type 2 diabetes mellitus.Methods：Totally 80 cases with newly diagnosed type 2 diabetes mellitus（NT2DM）,162 type 2 diabetes subjects with effective treatment by lifestyle intervention or oral hypoglycemic drugs therapy（LIODT）,160 subjects with insulin therapy（IT）,and 40 subjects with normal glucose level（NC）were admitted in the study in Department of Endocrinology,and the Physical Examination Center of Zhongshan Hospital,Fudan University.Arginine stimulation test was performed to assess the first-phase insulin secretion.Fasting and 2,4,6 min glucose（G）,insulin（I）and c-peptide（CP）after arginine stimulating were tested.Results：TheΔI,ΔI/G,ΔCP/G in arginine stimulation test were decreased significantly in the patients with NT2DM,LIODT and IT groups than those in the NC group（P〈0.01）.Among different groups of type 2 diabetes,ΔI,ΔCP,ΔI/G,ΔCP/G were decreased significantly in the IT group than the other two groups（P〈0.01）.The normal cut-off point of AIR wasΔI≥23.09 mU/L.ΔI,ΔI/G,ΔCP/G negatively correlated with fasting plasma glucose（FPG）and HbA1 c,andΔI,ΔCP,ΔI/G,ΔCP/G were negatively correlated with daily dose and numbers of oral diabetic medications after adjustment for gender,age,BMI.In the known type 2 diabetes groups（including LIODT and IT group）,the optimal cut-off values from ROC curve for initiating insulin therapy wereΔI≤12.23 mU/L,andΔCP≤0.97 ng/mL（P〈0.01）.Conclusions：Arginine stimulation test can effectively assess the first-phase insulin secretion.In type 2 diabetes,ΔI≤12.23 mU/L orΔCP≤0.97 ng/mL suggest severely lost of first-phase insulin secretion,and need insulin therapy.

关 键 词：精氨酸刺激试验 2型糖尿病 胰岛细胞功能 

分 类 号：R587.1[医药卫生—内分泌]