有恶性肿瘤病史的2型糖尿病患者的糖脂代谢及胰岛功能分析  

Giycolipid metabolism and islet β cell function in type 2 diabetic patients with a history ofmalignant tumor

作　　者：杨菊红[1] 张立弋 常宝成[1] 孔岩[1] 石珍珍 高忠爱[1] 单春艳[1] Yang Juhong;Zhang Liyi;Chang Baocheng;Kong Yan;Shi Zhenzhen;Gao Zhongai;Shan Chunyan.(Department of Diabetic Nephrology, the Metabolic Disease Hospital of Tianjin Medical University, Key Laboratory of the Ministry of Health of Hormones and Development, Tianjin 300070, Chin)

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》2018年第6期404-409,共6页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：国家自然科学基金面上项目（81373864、81473472、81603461）;天津市自然科学基金重点项目（17JCZDJC34700）;解放军总医院肾脏疾病国家重点实验室第一批开放课题基金（KF-01-133）

摘　　要：目的探讨具有恶性肿瘤病史的2型糖尿病患者的糖脂代谢及胰岛功能的变化特点，为临床防治提供依据。方法随机入选2014年3月至2016年7月于我院住院的2型糖尿病且既往具有恶性肿瘤病史的190例患者为病例组，选取同期与其年龄、性别和病程相匹配的704例糖尿病患者作为对照组。检测两组的糖脂代谢、口服75g葡萄糖后血糖、胰岛素及C肽水平。组间比较采用t检验、秩和检验或χ^2检验。结果（1）合并恶性肿瘤的患者其糖化血红蛋白（HbA1c）高于对照组（9.0%±1.9%比8.4%±1.9%，t=-3.197，P〈0.05），而总胆固醇、高密度脂蛋白胆固醇（HDL-C）及低密度脂蛋白胆固醇均低于对照组。此外，合并肿瘤患者的C肽曲线下面积[（12.1±5.1）比（9.4±4.2）mU，t=-3.490，P〈0.05]高于对照组，而外源性胰岛素剂量低于对照组[（24±14）比（31±16）U，t=4.795，P〈0.05]。两组胰岛素抵抗指数、胰岛功能指数及第一时相胰岛素分泌差异无统计学意义（均P〉0.05）。（2）逻辑回归分析显示，C肽曲线下面积（OR=1.189，95%CI 1.056-1.339，P=0.004）及HDL-C（OR=0.031，95%CI 0.002-0.474，P=0.013）与恶性肿瘤独立相关。结论有恶性肿瘤病史的2型糖尿病患者其内源性胰岛素水平升高，HDL-C水平下降，而HbA1c控制不达标。ObjectiveTo investigate the changes of glucose and lipid metabolism and islet function in type 2 diabetic patients with history of malignancy, and provide evidence for clinical prevention and treatment.MethodsA total of 190 cases of type 2 diabetes in our hospital from March 2014 to July 2016 with a history of malignant tumor were included. In addition, 704 age, gender and duration matched type 2 diabetic patients without tumor history were included as control. Markers of glucose metabolism, lipid metabolism, plasma insulin and C peptide levels after 75 g glucose load were detected. The t test, rank sum test and χ2 test were used to compare the differences between two groups.Results（1） In patients with history of malignant tumor, glycated hemoglobin A1c （HbA1c） was higher than that of the control group （9.0%±1.9% vs 8.4%±1.9%, t=-3.197, P〈0.05）; total cholesterol, high-density lipoprotein cholesterol （HDL-C） and low-density lipoprotein cholesterol were lower than control group. In addition, the area under curve of C-peptide after glucose load in patients with tumor was higher [（12.1±5.1） vs （9.4±4.2） mU, t=-3.490, P〈0.05] than that of control group, while the exogenous insulin dose was lower than that of control group [（24±14） vs （31±16） U, t=4.795, P〈0.05]. There was no difference in insulin resistance index, islet function index and first phase insulin secretion between the two groups. （2） Logistic regression analysis showed that C peptide the area under curve （OR=1.189, 95%CI 1.056-1.339, P=0.004） and HDL-C （OR=0.031, 95%CI 0.002-0.474, P=0.013） were independently associated with malignant tumor history.ConclusionType 2 diabetic patients with history of malignant tumor have high endogenous insulin levels but poor glycemic control. These patients are also with low HDL-C level.

关 键 词：糖尿病  2型 恶性肿瘤 糖代谢 脂代谢 胰岛功能 

分 类 号：R445.2[医药卫生—影像医学与核医学]