2型糖尿病患者空腹血糖与葡萄糖负荷后胰岛素峰值的相关性研究  

Relationship between Fasting Plasma Glucose and Peak Insulin Level after Glucose Load in Type 2 Diabetes Mellitus Patients

作　　者：廖世波[1] 吴敏[1] 黄淑玉[1] 邹毅[1] 朱钊[1] 黄高[1] 李玲[1] 向成 LIAO Shi-bo;WU Min;HUANG Shu-yu;ZOU Yi;ZHU Zhao;HUANG Gao;LI Ling;XIANG Cheng(Department of Endocrinology,Xiaogan Hospital Affiliated to Wuhan University of Science and Technology,Xiaogan 432000,China)

机构地区：[1]武汉科技大学附属孝感医院内分泌科,湖北省孝感市432000

出　　处：《中国全科医学》2018年第23期2795-2801,共7页Chinese General Practice

摘　　要：目的探讨2型糖尿病(T2DM)患者空腹血糖(FPG)对葡萄糖负荷后胰岛素峰值(INS_(max))的影响。方法选取2016年1月—2018年2月于武汉科技大学附属孝感医院内分泌科住院的T2DM患者548例,根据INS_(max)水平将其分为低INS_(max)组(INS_(max)≤30.0 mU/L,n=183)、中INS_(max)组(30.0 mU/L<INS_(max)≤62.5 mU/L,n=182)和高INS_(max)组(INS_(max)>62.5 mU/L,n=183)。收集患者的一般资料,检测糖化血红蛋白(HbA_(1c))、血酮体及血常规,行75 g葡萄糖耐量试验和胰岛素释放试验测量FPG、空腹胰岛素(FIns)、试验后30、60、120、180 min血糖(GLU)及胰岛素(INS),记录INS测量最大值(INSmeasuremax)、稳态模型胰岛β细胞功能指数(HOMA-β)、稳态模型胰岛素抵抗指数(HOMA-IR)。记录INS_(max)及达峰时间(tmax)、GLU峰值(GLUmax)及达峰时间(Tmax)、tmax与Tmax的差值(ΔT)。结果中INS_(max)组、高INS_(max)组的男性比例、HbA_(1c)、酮症发生率均低于低INS_(max)组,外源性胰岛素使用史、高血压病史、高尿酸血症/痛风病史、高血脂病史、非酒精性脂肪性肝病病史、体质指数(BMI)均高于低INS_(max)组(P<0.01);高INS_(max)组的红细胞分布宽度均高于低INS_(max)组,HbA_(1c)、血红蛋白(Hb)均低于中INS_(max)组(P<0.01)。低INS_(max)组FPG、30、60、120、180 min GLU、GLUmax、Tmax均高于中INS_(max)组和高INS_(max)组,FIns和30、60、120、180 min INS,INSmeasuremax、HOMA-β、HOMA-IR、ΔT均低于中INS_(max)组和高INS_(max)组(P<0.05);中INS_(max)组FPG和30、60、120、180 min GLU、GLUmax均高于高INS_(max)组,FIns、30、60、120、180 min INS、INSmeasuremax、HOMA-β、HOMA-IR、ΔT均低于高INS_(max)组(P<0.05)。INS_(max)与BMI、嗜酸粒细胞计数、FIns、30、60、120、180 min INS、HOMA-β、HOMA-IR、INSmeasuremax、ΔT呈正相关(P<0.05);INS_(max)与HbA_(1c)、Hb、FPG、30、60、120、180 min GLU、GLUmax、Tmax呈负相关(P<0.05)。多因素Logistic回归分析显示,高FPG、高180 min GLU是T2DM患者INS_(Objective To discuss the relationship between fasting plasma glucose(FPG)and peak insulin level(INSmax)after glucose load in type 2 diabetes mellitus(T2DM)patients.Methods We selected 548 hospitalized patients with T2DM from Department of Endocrinology,Xiaogan Hospital Affiliated to Wuhan University of Science and Technology from January 2016 to February 2018.According to INSmax,we divided them into low INSmax group(INSmax≤30.0 mU/L,n=183),medium INSmax group(30.0 mU/L<INSmax≤62.5 mU/L,n=182),and high INSmax group(INSmax>62.5 mU/L,n=183).We collected their clinical data,HbA1c and serum ketone bodies levels,routine blood test results,FPG,30,60,120,180 min blood glucose(GLU)levels(GLU levels measured at 30,60,120,180 min during a 3-hour 75 g oral glucose tolerance test)and fasting insulin(FIns)and 30,60,120,180 min INS levels(INS levels measured at 30,60,120,180 min during a 3-hour insulin response test),the time during which INS was at its peak(tmax),peak GLU level after glucose load(GLUmax)and the time during which GLU was at its peak(tmax),and calculated maximum INS level after glucose load(INSmeasuremax),homeostasis model assessment(HOMA)-β,HOMA-insulin resistance(IR),and the difference between tmax and Tmax(ΔT).Results Compared with low INSmax group,both medium and high INSmax groups showed lower male ratio,lower HbA1c level and lower incidence of ketosis but higher use rate of external insulin,higher prevalence of hypertension history,hyperuricemia/gout history,hyperlipidemia history,non-alcoholic fatty liver disease history as well as higher average body mass index(BMI)(P<0.01).High INSmax group had greater red blood cell distribution width compared with low INSmax group,and lower HbA1c and hemoglobin(Hb)compared with medium INSmax group(P<0.01).In comparison with other two groups,low INSmax group demonstrated higher FPG and 30,60,120,180 min GLU,GLUmax,Tmax and lower FIns as well as 30,60,120,180 min INS(P<0.05).Moreover,it presented greater GLUmax and Tmax and less INSmeasuremax,HOMA-β,HOMA-IR andΔ

关 键 词：糖尿病 2型 血糖 胰岛素 葡糖耐量试验 

分 类 号：R587.1[医药卫生—内分泌]