2型糖尿病胰岛素强化治疗后胰岛β细胞功能变化及影响因素分析  

Analysis of the change in isletβ⁃cell function and influencing factors after intensive insulin treatment in type 2 diabetes

作　　者：王若梅 陈婧 雷远 刘燕 杜娟[1] 汪睿 张静漪 王佑民[2] WANG Ruomei;CHEN Jing;LEI Yuan;LIU Yan;DU Juan;WANG Rui;ZHANG Jingyi;WANG Youmin(Department of Endocrinology and Metabolism Disease,The Fourth Affiliated Hospital of Anhui Medical University,Hefei,Anhui 238000,China;Department of Endocrinology and Metabolism Disease,The First Affiliated Hospital of Anhui Medical University,Hefei,Anhui 230022,China)

机构地区：[1]安徽医科大学第四附属医院内分泌与代谢病科,安徽合肥238000 [2]安徽医科大学第一附属医院内分泌与代谢病科,安徽合肥230022

出　　处：《安徽医药》2020年第9期1806-1810,共5页Anhui Medical and Pharmaceutical Journal

摘　　要：目的了解2型糖尿病(T2DM)病人经胰岛素多次皮下注射(multiple daily injections,MDI)强化治疗后胰岛β细胞的功能变化并分析可能的影响因素。方法选取2018年9月至2019年11月在安徽医科大学第四附属医院内分泌与代谢病科住院治疗的T2DM病人,收集相关基线资料并行馒头餐试验,所有病人给予5~7 d MDI强化治疗,待血糖达标后再次行馒头餐试验,计算治疗期间0 h C肽下降幅度(Δ0 h CP%)、馒头餐试验C肽增加值(CPi)及其下降幅度差值(ΔCPi%)、C肽曲线下面积(AUC_(CP))及其上升幅度(ΔAUC_(CP)%)、2.0 h C肽/0 h C肽及Δ2.0 h C肽/Δ2.0 h血糖等指标以评估病人胰岛β细胞功能,采用Spearman法分析两组变量间的相关性。结果 (1)MDI强化治疗后,馒头餐试验各点血糖及血糖曲线下面积降低,CPi、2.0 h C肽/0 h C肽及Δ2.0 h C肽/Δ2.0 h血糖升高,其中治疗前比治疗后0 h血糖、2.0 h血糖、CPi、2.0 h C肽/0 h C肽、Δ2.0 h C肽/Δ2.0 h血糖分别为[(9.35±3.47)mmol/L比(5.87±1.67)mmol/L,t=8.435,P=0.000],[(17.33±4.18)mmol/L比(12.98±3.09)mmol/L,t=7.808,P=0.000],[(1.38±1.27)ng/mL比(1.91±1.17)ng/mL,t=-2.896,P=0.004],[(2.61±2.89)比(4.02±3.37),t=-2.959,P=0.004],[(16.44±20.39)比(27.82±22.35),t=-3.507,P=0.001];(2)0 h C肽水平与体质量指数(BMI)水平正相关(r=0.375,P=0.000),与糖化血红蛋白(HbA1c)水平、Δ0 h CP%水平及病程负相关,其相关系数依次为(r=-0.344,P=0.001)、(r=-0.508,P=0.000)、(r=-0.257,P=0.016);(3)有症状T2DM病人血糖高于无症状T2DM病人,C肽水平反之,其中无症状比有症状T2DM病人治疗前3.0 h血糖曲线下面积、治疗后3.0 h血糖曲线下面积、治疗前3.0 h AUC_(CP)、治疗后3.0 h AUC_(CP)分别为[(40.16±8.06)比(51.35±11.12),t=-5.437,P=0.000],[(30.56±5.66)比(35.18±9.36),t=-2.848,P=0.006],[(6.48±4.16)比(4.15±2.27),t=3.110,P=0.003],[(7.05±3.98)比(4.49±2.79),t=3.380,P=0.001];(4)Δ0 h CP%、ΔCPi%水平与MDI治疗前0 h血糖水平正相关,其相关系数依次�Objective To explore the change of isletβcell function during multiple daily injections(MDI)of insulin in type 2 dia⁃betic mellitus(T2DM)and analyze the possible influencing factors.Methods Collected the relevant baseline data of the selected type 2 diabetic patients who hospitalized in the Department of Endocrinology and Metabolism Disease of The Fourth Affiliated Hos⁃pital of Anhui Medical University from September 2018 to November 2019.The steamed bread meal test was performed.All patients were given 5⁃7 days MDI treatment.Conducted the test again after the blood glucose reached the standard level.Calculated the de⁃clined range of the 0 h C⁃peptide(Δ0 h CP%),the C⁃peptide increase value(CPi)of the steamed bread meal test and the differ⁃ence in the decrease(ΔCPi%),the area under the C⁃peptide curve(AUCCP)and its ascensional range(ΔAUCCP%),2.0 h CP/0 h CP andΔ2.0 h CP/Δ2.0 h BG etc to assess the patients’isletβ⁃cell function.Spearman method was used to analyze the correlation between the two groups of variables.Results(1)The blood glucose(BG)and the area under the glucose curve of each steamed bread meal test time point decreased after the MDI treatment,while CPi、2.0 h CP/0 h CP andΔ2.0 h CP/Δ2.0 h BG increased.The indexes before and after treatment were respectively[(9.35±3.47)mmol/L vs.(5.87±1.67)mmol/L,t=8.435,P=0.000],[(17.33±4.18)mmol/L vs.(12.98±3.09)mmol/L,t=7.808,P=0.000],[(1.38±1.27)ng/mL vs.(1.91±1.17)ng/mL,t=-2.896,P=0.004],[(2.61±2.89)vs.(4.02±3.37),t=-2.959,P=0.004],[(16.44±20.39)vs.(27.82±22.35),t=-3.507,P=0.001];(2)0 h CP posi⁃tively related to the body mass index(BMI)(r=0.375,P=0.000),negatively related to glycosylated hemoglobin(HbA1c),Δ0 h CP%and course of disease respectively[(r=-0.344,P=0.001),(r=-0.508,P=0.000),(r=-0.257,P=0.016)];(3)The blood glucose level of symptomatic T2DM patients was higher than that of asymptomatic T2DM patients,and the c⁃peptide level was on the contrary.Among them,the 3.0 h areas under the glucose curve(3.0 h AUCBG)befor

关 键 词：糖尿病 2型/治疗 葡糖耐量试验 C肽 血红蛋白A 糖基化 强化治疗 胰岛Β细胞功能 

分 类 号：R587.1[医药卫生—内分泌]