口服降糖药继发失效的2型糖尿病患者β细胞功能及其影响因素  

β-cell Function and its Associated Factors in Type 2 Diabetes with Secondary Failure to Oral Hypoglycemic Agents

作　　者：朱大龙[1] 胡云[1] 顾经宇[1] 沈山梅[1] 林凌[1] 黄洪[1] 

机构地区：[1]南京大学医学院附属南京鼓楼医院内分泌科,南京210008

出　　处：《南京大学学报（自然科学版）》2002年第5期656-661,共6页Journal of Nanjing University（Natural Science）

摘　　要：　为研究口服降糖药继发失效的2型糖尿病患者内源性胰岛β细胞功能及病程、肥胖、血脂等因素对其的影响.以98例住院的2型糖尿病患者为研究对象,静脉注射1mg胰高血糖素,刺激前和刺激后6min的ΔCP值表示内源性胰岛β细胞分泌功能.根据体重指数(bodymassindex,BMI)、病程和口服降糖药(oralhypoglycemicagents,OHA)有效和继发失效(secondaryfailure,SF)分组,比较各组ΔCP值,分析BMI、病程等对ΔCP值的影响.结果发现:①空腹C肽(F CP)随BMI增加而增加,BMI<23、23≤BMI<25、BMI≥25组间比较有显著性差异(P<0.01),但ΔCP三组间无明显差异.②ΔCP随病程的延长呈进行性下降(P<0.05),病程小于5年、5～10年和大于10年各组中发生口服降糖药继发失效的分别为58%、76%、89%.③非肥胖(BMI<23和23≤BMI<25)组:SF发生率分别为79%、68%,SF组ΔCP均比OHA组显著降低(P<0.001).肥胖(BMI≥25)组:SF发生率为69%,SF组ΔCP比OHA组低,无显著性差异.SF组病程比OHA组病程长(P<0.05).④ΔCP与BMI、TG呈正相关(r=0.33,P=0.001;r=0.33,P=0.001),与病程呈负相关(r=-0.31,P=0.002).多元逐步回归分析示病程对ΔCP影响较大.表明肥胖的2型糖尿病在疾病的早几年比非肥胖的2型糖尿病存在明显高胰岛素血症.内源性胰岛β细胞分泌功能主要与病程有?We studied the endogenetic βcell function in type 2 diabetic patients in relation to diabetes duration, obesity,and the presence of secondary failure to oral hypoglycemic agents. 98 type 2 diabetic subjects were studied. Endogenetic βcell function was assessed by measuring fasting C peptide and 6minuteCpeptide after intravenous 1 mg glucagons stimulation test. On the basis of their BMI, diabetic duration, and the presence of secondary failure to oral hypoglycemic agents they were divided into groups. Multiple regression analysis with the stepwise regression procedure was used to explore the influence of multiple variables on ΔCP. The results showed: ①With BMI increasing, Fcp was significantly higher (P<0.001) and ΔCP was not different. ②ΔCP values showed a progressive decrease with diabetic duration increasing. The prevalence of SF in three subgroups devided according to duration of disease (<5 years,5～10 years and >10 years)was 58%,76% and 89% respectively.③The prevalence of SF was 79%,68% respectively in nonobese (BMI<23 and 23≤BMI<25) and 69% in obese (BMI≥25). ΔCP was significantly lower in nonobese SF than in nonobese OHA(P<0.001) and not significantly different between obese SF and obese OHA. Diabetic duration in obese SF was longer than that in obese OHA(P<0.05). ④ΔCP was correlated with BMI,TG (r=0.33,P=0.001; r=0.33,P=0.001)and ΔCP was inversely associated with duration of diabetes. Multiple regression analysis demonstrated that ΔCP was mainly dependent on duration of diabetes. The results of this study demonstrate that obese type 2 diabetes display higher insulin secretion than nonobese patients, especially in the early years of the disease. Endogenetic βcell function is mainly influenced by diabetes duration. The progressive decrease of βcell function is the major factor in the onset of secondary failure to oral hypoglycemic agents for both obese and nonobese type 2 diabetes.

关 键 词：患者 影响因素 2型糖尿病 胰高血糖素刺激试验 内源性胰岛β细胞 分泌功能 口服降糖药继发失效 

分 类 号：R587.1[医药卫生—内分泌]