2型糖尿病患者24 h尿糖与胰岛素抵抗的关系  

Relationship between 24-h Urine Glucose and Insulin Resistance in Patients with Type 2 Diabetes Mellitus

作　　者：韩晓菁 岳月仪 徐曼灵 朱静波 鲁燕[1] 蒋伏松[2] HAN Xiaojing;YUE Yueyi;XU Manling;ZHU Jingbo;LU Yan;JIANG Fusong(Department of Endocrinology,the First Affiliated Hospital of Soochow University,Suzhou,Jiangsu Province,215000 China;Department of Endocrinology and Metabolism,the Sixth People's Hospital Affiliated to Shanghai Jiaotong University,Shanghai,201306 China)

机构地区：[1]苏州大学附属第一医院内分泌科,江苏苏州215000 [2]上海交通大学附属第六人民医院内分泌代谢科,上海201306

出　　处：《糖尿病新世界》2023年第8期1-5,27,共6页Diabetes New World Magazine

基　　金：上海市信息化发展专项资金(201701014)。

摘　　要：目的探讨2型糖尿病(type 2 diabetes mellitus,T2DM)患者24 h尿糖与胰岛素抵抗(insulin resistance,IR)的关系。方法采用回顾性分析法,选取2016年6月—2019年1月上海交通大学附属第六人民医院收治的1143例2型糖尿病患者,包括电子病案中病史、体格检查、血液生化指标检测及24 h尿糖检测等信息,根据24 h尿糖中位数分为低UGlu组572例和高UGlu组571例。比较两组性别、年龄、病程、血脂、血糖、胰岛素水平、糖化血红蛋白(HbA1c)、体质指数(BMI)、腰围(WC)等指标的水平,并计算胰岛素抵抗指数(HOMA-IR)、胰岛β细胞功能指数(HOMA-β)。结果两组病程、高血压史、体质指数(BMI)、腰围(WC)、空腹胰岛素(INS)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)比较,差异无统计学意义(P>0.05)。两组年龄、性别、吸烟史、饮酒史、糖化血红蛋白(HbA1c)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FPG)、餐后2 h血糖(2 hPG)、餐后2 h胰岛素(2 h-INS)、胰岛素抵抗指数(HOMAIR)、胰岛β细胞功能指数(HOMA-β)、肾小球滤过率(eGFR)比较,差异有统计学意义(P<0.05)。Spearman相关分析显示,24 h尿糖与HOMA-IR呈正相关(r=0.236,P<0.001),而与餐后2 h胰岛素水平呈负相关(r=-0.128,P<0.001)。结果显示,24 h尿糖与FPG、2 hPG、HbA1c、TC、LDL-C、ECFR呈显著正相关;而与年龄、HOMA-β呈显著负相关。多元线性回归分析显示,校正混杂因素后FPG、2 hPG、HbA1c、2 h-INS、HOMAIR、eGFR均为24 h尿糖的影响因素。结论T2DM患者HOMA-IR、2 h-INS水平与24 h尿糖排泄量呈正相关。胰岛素抵抗程度可能是全天尿糖排泄的预测因素。Objective To investigate the relationship between 24-h urine glucose and insulin resistance(IR)in patients with type 2 diabetes mellitus(T2DM).Methods Using retrospective analysis,1143 patients with type 2 diabetes mellitus admitted to the Sixth People's Hospital Affiliated to Shanghai Jiaotong University from June 2016 to January 2019,including information on medical history,physical examination,blood biochemical index test and 24-h urine glucose test in electronic medical case,were selected and divided into 572 cases in the low UGlu group and 571 cases in the high UGlu group according to the median 24-h urine glucose.The levels of gender,age,disease duration,blood lipids,blood glucose,insulin level,glycosylated hemoglobin(HbA1c),body mass index(BMI),waist circumference(WC)and other indexes were compared between the two groups,and insulin resistance index(HOMA-IR)and pancreaticβ-cell function index(HOMA-β)were calculated.Results There was no statistically significant difference in the course of disease,history of hypertension,body mass index(BMI),waist circumference(WC),fasting insulin(INS),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C)between the two groups(P>0.05).Age,gender,smoking history,drinking history,glycated hemoglobin(HbA1c),total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),Glucose fasting blood sugar(FPG),2-hour postprandial blood glucose(2 hPG),postprandial 2 h insulin(2 h-INS),insulin resistance index(HOMA⁃IR),isletsβCellular Function Index(HOMA-β),the glomerular filtration rate(eGFR)between two groups were compared,the difference was statistically significant(P<0.05).Spearman correlation analysis showed that 24-h urine glucose was positively correlated with HOMA-IR(r=0.236,P<0.001),while it was negatively correlated with prandial insulin levels(r=-0.128,P<0.001).The results showed that 24-hour urine glucose was significantly positively correlated with FPG,2 hPG,HbA1c,TC,LDL-C,ECFR,and negatively correlated with age and HOMA-β.Multiple linear regression analysis

关 键 词：2型糖尿病 24 h尿糖 肾糖阈 胰岛素抵抗 

分 类 号：R587.1[医药卫生—内分泌]