口服葡萄糖耐量-胰岛素/C肽释放试验对慢性胰腺炎患者糖耐量异常的诊断价值  

Diagnostic value of oral glucose tolerance-insulin/C peptide release test in chronic pancreatitis patients with impaired glucose tolerance

作　　者：潘云 胡良皞 徐茂锦 Pan Yun;Hu Lianghao;Xu Maojin(Department of Endocrinology, Changhai Hospital, Navy Medical University, Shanghai 200433, China;Department of Gastroenterology, Changhai Hospital, Navy Medical University, Shanghai 200433, China)

机构地区：[1]海军军医大学附属长海医院内分泌科,上海200433 [2]海军军医大学附属长海医院消化内科,上海200433

出　　处：《中华胰腺病杂志》2019年第2期118-122,共5页Chinese Journal of Pancreatology

摘　　要：目的探讨口服葡萄糖耐量(OGTT)-胰岛素/C肽释放试验对慢性胰腺炎(CP)相关性糖耐量异常的早期诊断价值。方法收集2017年6月至2018年2月间上海长海医院消化内科收治的60例CP患者,通过既往病史和OGTT-胰岛素/C肽释放试验将CP患者分为CP糖耐量正常(CP-NGT)组、CP糖耐量减低(CP-IGT)组、CP合并新诊断糖尿病(CP-new-DM)组及CP合并既往糖尿病(CP-history-DM)组,比较4组患者糖代谢水平及血糖、胰岛素、C肽释放量的变化。结果 43例既往无糖尿病病史的CP患者通过空腹血糖或糖化血红蛋白检测出6例(14.0%)糖代谢异常,而通过OGTT-胰岛素/C肽释放试验检出30例(69.8%)糖代谢异常,糖代谢异常检出率提高了55.8%。CP-history-DM组血糖、胰岛素、C肽的分泌高峰均在120 min,与CP-NGT组、CP-IGT组、CP-new-DM组比较,C肽释放量增加倍数(峰值/基线)[4.1(3.4,4.4)倍比(6.1±2.2)、(6.4±2.5)、(6.8±3.8)倍]、C肽曲线下面积[(3.6±1.4)μg·h^-1·L^-1比8.6(7.1,9.7)、(8.1±3.1)、(6.9±2.7)μg·h^-1·L^-1]、胰岛β细胞分泌指数[24.4(11.4,37.4)比52.4(44.6,92.1)、89.8±57.2、72.4±57.0]均显著降低,差异有统计学意义(P值均<0.05)。CP-new-DM组血糖分泌高峰在60 min,胰岛素、C肽分泌高峰在120 min,与CP-NGT组比较,早期胰岛素分泌指数[2.2(0.8,4.2)比11.4±9.4]和胰岛素分泌敏感性指数-2[256.1(160.1,340.7)比548.5±173.2]均显著降低,差异有统计学意义(P值均<0.05)。结论 CP相关性糖尿病病程早期即存在胰岛素、C肽早期时相的分泌不足。CP患者常规行OGTT-胰岛素/C肽释放试验可以提高糖代谢异常的检出率。Objectives To investigate the value of oral glucose tolerance (OGTT)-insulin/C peptide release test in early diagnosis of chronic pancreatitis (CP)- associated abnormal glucose tolerance. Methods Sixty patients with CP who were admitted to the Department of Gastroenterology, Changhai Hospital from June 2017 to February 2018 were divided into CP with normal glucose tolerance (CP-NGT), CP with impaired glucose tolerance (CP-IGT), CP with newly diagnosed diabetes(CP-new-DM) and CP with the previous history of diabetes (CP-history-DM) according to previous medical records and data from OGTT-insulin/C peptide release test. The characteristics of glucose metabolism, the changes of blood glucose, insulin and C peptide released among the four groups were compared. Results In 43 cases of patients with CP without diabetes, the abnormal glucose metabolism was detected in 6 cases (14.0%) by fasting blood glucose or glycosylated hemoglobin, and in 30 cases (69.8%) by OGTT- insulin/C-peptide release test. The detection rate of abnormal glucose metabolism was increased by 55.8%. In the group of CP-history-DM, the peak secretion of blood glucose, insulin, C peptide was all at 120 min, and the multiplication of increased release of C peptide (peak/baseline)[4.1(3.4, 4.4) vs (6.1±2.2)、(6.4±2.5)、(6.8±3.8)], the C peptide area under curve (C-PAUC)[(3.6±1.4)]μg·h^-1·L^-1vs 8.6(7.1, 9.7),(8.1±3.1),(6.9±2.7)μg·h^-1·L^-1]and the homeostasis model of assessment for β cell (HOMA-β)[24.4(11.4, 37.4) vs 52.4(44.6, 92.1),(89.8±57.2),(72.4±57.0)]were all significantly lower, and the difference was statistically significant(all P<0.05). In the group of CP-new-DM, the peak of blood glucose was at 60 min, while the peak of insulin, C peptide was at 120 min, the early insulin secretion index (△I30/△G30)[2.2(0.8, 4.2) vs (11.4±9.4)]and insulin secretion sensitivity index-2 (ISSI-2)[256.1(160.1, 340.7) vs (548.5±173.2)] in group of CP-new-DM were significantly lower than those in the group of CP-NGT, and the difference was

关 键 词：胰腺炎 慢性 糖尿病 葡萄糖耐量试验 胰岛素/C肽释放试验 葡萄糖代谢障碍 

分 类 号：R576[医药卫生—消化系统]