2型糖尿病患者肾糖阈升高与胰岛素抵抗相关性研究  

An exploratory study of the association between elevated renal glucose threshold and insulin resistance in type 2 diabetes mellitus

作　　者：王海军[1] 徐杰[2] 杨琼 陈霞[1] WANG Haijun;XU Jie;YANG Qiong(Department of Endocrinology,Yan’an People’s Hospital,Yan'an 716000,China)

机构地区：[1]延安市人民医院内分泌科,716000 [2]延安大学附属医院内分泌代谢科

出　　处：《中国糖尿病杂志》2022年第7期481-485,共5页Chinese Journal of Diabetes

基　　金：陕西省教育厅专项科研计划项目(13JK0781)。

摘　　要：目的 探讨T2DM患者肾糖阈(RTg)升高与IR的相关性。方法 选取2019年4~12月于延安市人民医院内分泌科治疗的T2DM患者67例。采用高胰岛素-正葡萄糖钳夹技术评估稳态葡萄糖输注率(GIR)作为IS指标,评价RTg。根据RTg值将患者分为高RTg组(RTg≥180 mg/dl)35例和低RTg组(RTg<180 mg/dl)32例。Pearson相关分析RTg与各指标的相关性,分析不同GIR的RTg临界值。结果 与低RTg组比较,高RTg组GIR降低,HbA1c升高(P<0.01)。Pearson相关分析显示,RTg与HbA1c呈正相关(P<0.01),与肌肉-脂肪比、GIR呈负相关(P<0.05或P<0.01)。多元线性回归分析显示,校正混杂因素后GIR和HbA1c均为RTg的影响因素。受试者工作特征曲线分析显示,以GIR<5.7作为IR阈值时,RTg临界值为189 mg/dl(P<0.001)。结论 高RTg与低GIR和高HbA1c相关,GIR在RTg升高中发挥重要作用,尿糖阴性的高血糖患者有IR和/或HbA1c≥8.0%。T2DM患者RTg升高时应及时关注IR。Objective To investigate the association between renal glucose threshold for glucose(RTg)and insulin resistance(IR)in patients with type 2 diabetes mellitus(T2DM).Methods From April2019 to December 2019,67 patients with T2DM were enrolled. Steady-state glucose infusion rate(GIR)as an insulin sensitivity(IS)indicator was assessed using the hyperinsulinemic-euglycemic clamp(HEC)technique.According to RTg,the patients were divided into high RTg group(RTg≥180 mg/dl,n=35)and low RTg group(RTg<180 mg/dl,n=32).Results Compared with the low RTg group,GIR of the high RTg group was decreased,and glycated hemoglobin(HbA1c)was increased(P<0. 01). Pearson correlation analysis showed a negative correlation between RTg and GIR(P<0. 01),and a positive correlation between RTg and HbA1c(P<0. 01). After adjusting for confounders,GIR and HbA1c were independent influencing factors for RTg. Receiver operating characteristic curve(ROC)analysis showed that the cut-off value of RTg was 189 mg/dl when GIR < 5. 7 was used as IR threshold(P<0. 001).Conclusion High RTg was independently associated with low GIR and high HbA1c. GIR played an important role in the elevation of RTg. Hyperglycemic patients with negative urine glucose have IR and/or an HbA1c≥8. 0%. Attention should be paid to the possibility of IR when RTg is elevated in T2DM patients.

关 键 词：糖尿病 2型 肾糖阈 胰岛素抵抗 高胰岛素-正葡萄糖钳夹技术 

分 类 号：R587.1[医药卫生—内分泌]