2型糖尿病患者胰岛α细胞和β细胞关系的研究  

Relationship between pancreatic α cell and pancreatic β cell in patients with type 2 diabetes

作　　者：王春华[1] 苏建彬[1] 万洋洋[1] 王雪琴[1] WANG Chun-hua;SU Jian-bin;WAN Yang-yang;WANG Xue-qin(Department of Endocrinology,The First People＇s Hospital of Nantong City,Jiangsu Nantong 226001,China)

机构地区：[1]江苏省南通市第一人民医院内分泌科,江苏南通226001

出　　处：《中国医刊》2018年第8期879-882,共4页Chinese Journal of Medicine

基　　金：江苏省卫计委基金资助(H201553)

摘　　要：目的探讨2型糖尿病患者胰岛α细胞和β细胞的关系。方法将455例2型糖尿病患者根据空腹C肽水平及C肽增量(ΔC肽)分为A组(空腹C肽<1.9ng/ml,ΔC肽<1.1ng/ml)、B组(空腹C肽<1.9ng/ml,ΔC肽≥1.1ng/ml)、C组(C肽≥1.9ng/ml,ΔC肽<1.1ng/ml)和D组(C肽≥1.9ng/ml,ΔC肽≥1.1ng/ml),比较4组的性别构成、年龄、体重指数、血压、糖化血红蛋白、血脂、尿酸、空腹血糖及病程。行口服葡萄糖耐量试验及C肽、胰高血糖素释放试验,比较4组在试验前后各时间点血糖与胰高血糖素的比值(PG/GLA)及其ROC曲线下面积(AUCPG/GLA)的变化,并对C肽ROC曲线下面积(AUCC肽)及AUCPG/GLA等指标行相关性分析。结果 4组的性别构成、年龄、收缩压、舒张压、总胆固醇、低密度脂蛋白胆固醇比较差异无显著性(P>0.05),体重指数、糖化血红蛋白、甘油三酯、高密度脂蛋白胆固醇、尿酸、空腹血糖及病程比较差异有显著性(P<0.05)。4组在口服葡萄糖耐量试验前后各时间点PG/GLA及AUC_(PG/GLA)比较差异有显著性(P<0.05)。Pearson相关分析显示,AUC_(PG/GLA)与AUC_(C肽)呈负相关(r=-0.353,P<0.01),多元逐步回归分析显示AUCPG/GLA与糖化血红蛋白(B=0.278,t=5.012,P<0.01)、空腹血糖(B=0.131,t=2.970,P<0.01)呈正相关。结论 2型糖尿病患者C肽和胰高血糖素之间关系密切,互为抑制,互为反馈。在保护胰岛β细胞功能的同时纠正胰岛α细胞功能的异常才能更好地控制血糖。Objective To explore the relationship of C-peptide and glucagon in patients with type 2 diabetes. Method According to the level of fasting C-peptide as well as the increment of C-peptide （delta C-peptide）, 455 patients with type 2 diabetes were stratified into four groups, group A （fasting C-peptide 〈 1.9ng/ml, delta C-peptide 〈 1.1 ng/ml）, group B （fasting C-peptide 〈 1.9ng/ml, delta C-peptide ≥ 1. 1 ng/ml）, group C （fasting C-peptide ≥ 1.9ng/ml, delta C-peptide〈 1.1 ng/ml） and group D （fasting C-peptide ≥1.9ng/ml, delta C-peptide ≥ 1.1ng/ml）. ANOVA tests were performed to make comparison of sex, age, BMI, blood pressure, hemoglobin, lipids, uric acid, fasting plasma glucose and duration of disease among the four groups. All patients were given oral glucose tolerance test, C-peptide and glucagon release tests. Plasma glucose/glucagon （PG/GLA）, area under the curve of PG/GLA （AUCPG/CLA） and area under the curve of C-peptide （AUCc-peptide） were all measured at each time point. Pearson correlation analysis was performed. Result There were significant difference in BMI, hemoglobin, triglyceride, high-density lipoprotein, uric acid, fasting plasma glucose and duration of disease among the four groups （P 〈0.05）. However, we found no difference in sex, age, systolic blood pressure, diastolic blood pressure, total cholesterol and low-density lipoprotein （P〉0.05）. In addition, there were also obvious difference in PG/GLA and AUCPG/6LA at each time point （P〈 0.05）. Pearson correlation analysis showed that AUCPG/GLA was negatively related with AUCc-peptide （r=-0.353, P〈0.01）. Multiple stepwise regression revealed that AUCPG/CLA was positively related with hemoglobin （B=0.278, P〈0.01） and fasting glucose （B=0.13 1, P〈0.01）. Conclusion C-peptide and glucagon in patients with type 2 diabetes had a close relationship by which they promoted or restrained each other. Protection of pancreatic β-cell and regulation the abnormal function of a-cell

关 键 词：2型糖尿病 胰岛Α细胞 胰岛Β细胞 

分 类 号：R587.1[医药卫生—内分泌] R532.23[医药卫生—内科学]