糖化血红蛋白与胰岛功能水平变化在糖尿病中的应用  

Application of changes of glycosylated hemoglobin and islet function in diabetes mellitus

作　　者：李熙建[1] 王福莲 泽拥吉 巴姆 刘影[1] 谭同均[1] LI Xijian;WANG Fulian;ZE Yongji;BA Mu;LIU Ying;TANG Tongjun(Department of Clinical Laboratory,The First People′s Hospital of Yibin,Yibin,Sichuan 644000,China;Department of clinical laboratory,XinLong Country People′s Hospital in Garze Tibetan Autonomous Prefecture,Garze,Sichuan 626800,China)

机构地区：[1]宜宾市第一人民医院检验科,四川宜宾644000 [2]甘孜藏族自治州新龙县人民医院检验科,四川甘孜626800

出　　处：《国际检验医学杂志》2019年第20期2546-2550,共5页International Journal of Laboratory Medicine

摘　　要：目的比较不同糖化血红蛋白A1c(HbA1c)水平的2型糖尿病(T2DM)患者胰岛功能状态,探讨HbA1c分层研究对糖尿病的诊断和治疗价值。方法收集来四川省宜宾市第一人民医院诊治的患者299例,根据HbA1c水平分为6组,A组78例,HbA1c<6.5%,B组42例,6.5%≤HbA1c<7.0%,C组48例,7.0%≤HbA1c<8.0%,D组42例,8.0%≤HbA1c<9.0%,E组48例,9.0%≤HbA1c<12.0%,F组41例,HbA1c≥12.0%,采用标准餐试验,比较各组空腹血糖(FPG)、1 hPG、2 hPG、3 hPG和空腹胰岛素(FIns)、1 hIns、2 hIns、3 hIns及空腹C肽(FC-P)、1 hC-P、2 hC-P、3 hC-P的水平,并对检验结果进行统计分析。结果随着HbA1c水平升高,FPG、1 hPG、2 hPG均明显升高,呈明显的正相关性;在HbA1c<9.0%时,随着HbA1c水平升高,2 hIns、1 hC-P、2 hC-P、3 hC-P下降明显,呈显著的负相关性,当HbA1c≥10.39%时,糖耐量的相关性下降,Ins和C肽功能变化的几个指标均处于正常或较低的水平,与HbA1c的水平呈较明显的负相关性。结论联合HbA1c检测糖耐量和胰岛素释放试验,有助于较准确地了解胰岛β细胞的功能状态。其水平变化对于T2DM患者血糖水平的监控,以及判定胰岛β细胞的功能,防止糖尿病患者被漏诊,及在防止血糖产生较大的波动和指导治疗方面,有较积极的意义和较高的应用价值。Objective To compare the islet function of patients with type 2 diabetes mellitus(T2DM)with different levels of glycosylated hemoglobin A1C(HbA1c),and to explore the value of hierarchical study of HbA1c in the diagnosis and treatment of diabetes mellitus.Methods A total of 299 patients were collected from the First People′s Hospital of Yibin City,Sichuan Province.According to the level of HbA1c,they were divided into six groups:group A,78 cases,HbA1c<6.5%,group B,42 cases,6.5%≤HbA1c<7.0%,group C,48 cases,7.0%≤HbA1c<8.0%,group D,42 cases,8.0%≤HbA1c<9.0%,group E,9.0%≤HbA1c<12.0%,group F,41 cases,HbA1c≥12.0%.The levels of FPG(fasting plasma glucose),1hPG,2hPG,3hPG and FIns(fasting insulin),1hIns,2hIns,3hIns and FC-P(fasting C-peptide),1 hC-P,2 hC-P and 3 hC-P in each group were compared by standard meal test,and the test results were analyzed statistically.Results FPG,1hPG and 2hPG increased significantly with the increase of HbA1c level,showing a significant positive correlation.When HbA1c<9.0%,with the increase of HbA1c level,2 hIns,1 hC-P,2 hC-P and 3 hC-P decreased significantly,showing a significant negative correlation.When HbA1c≥10.39%,the correlation of glucose tolerance decreased,and the function of Ins and C-peptide changed several times.Indicators were at normal or low levels,and there was a significant negative correlation with HbA1c level.Conclusion The combination of HbA1c and insulin release test is helpful to understand the function of islet beta cells more accurately.The changes of blood sugar level have positive significance and high application value in monitoring blood sugar level of patients with T2DM,judging the function of islet beta cells,preventing diabetic patients from being missed diagnosis,preventing blood sugar fluctuation and guiding treatment.

关 键 词：糖化血红蛋白A1C 2型糖尿病 胰岛素 C肽 胰岛功能 

分 类 号：R446.1[医药卫生—诊断学] R587.1[医药卫生—临床医学]