2型糖尿病患者血清胆碱酯酶水平与胰岛α细胞功能受损的相关性研究  

Relationship between serum cholinesterase levels and isletαcell dysfunction in patients with type 2 diabetes mellitus

作　　者：苏建彬[1] 徐峰[1] 王春华[1] 赵丽华[1] 段程伟 张冬梅[2] 王雪琴[1] Su Jianbin;Xu Feng;Wang Chunhua;Zhao Lihua;Duan Chengwei;Zhang Dongmei;Wang Xueqin(Department of Endocrinology,the Second Affiliated Hospital of Nantong University,First People′s Hospital of Nantong,Nantong 226001,China;Medical Research Center,the Second Affiliated Hospital of Nantong University,First People′s Hospital of Nantong,Nantong 226001,China)

机构地区：[1]南通市第一人民医院,南通大学第二附属医院内分泌科,南通226001 [2]南通市第一人民医院,南通大学第二附属医院临床医学中心,南通226001

出　　处：《中华糖尿病杂志》2024年第8期857-863,共7页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：江苏省卫生健康委员会科研项目(Z2022058);南通市科技局科研项目(MS12019019、MS2023083)。

摘　　要：目的探讨血清胆碱酯酶(ChE)水平与2型糖尿病(T2DM)胰岛α细胞功能受损的相关性。方法本研究为横断面研究。选择自2022年7月至2023年12月在南通市第一人民医院内分泌科就诊的T2DM患者作为研究对象。收集入组患者的年龄、性别、血压、体重指数(BMI)等人体参数;记录糖尿病病程和用药处方(降糖药物和他汀类药物);检测血清ChE、肝功能指标、血脂、血肌酐(SCr)、尿酸(UA)、胱抑素C(CysC)和糖化血红蛋白(HbA_(1c))等;进行75 g口服葡萄糖耐量试验,同步检测空腹(0 min)、糖负荷后30、60、120和180 min葡萄糖、胰岛素及胰高糖素(GLA)。采用稳态模型评估胰岛素抵抗指数(HOMA-IR)评估胰岛素抵抗。使用葡萄糖曲线下面积(AUC_(glu))评估糖负荷后总体血糖水平。胰岛α细胞功能指标包括GLA_(0)、GLA_(30)、GLA_(60)、GLA_(120)、糖负荷后总体GLA水平[GLA曲线下面积(AUC_(gla))]。根据血清ChE水平进行三分位数分组:T_(1)组(血清ChE 3.71~7.84 kU/L,167例)、T_(2)组(血清ChE 7.85~9.44 kU/L,168例)和T_(3)组(血清ChE 9.45~17.94 kU/L,167例)。使用线性多项式对比的单因素方差分析、Jonckheere-Terpstra检验或线性相关的χ^(2)检验分析临床资料在组间变化的趋势;使用Pearson相关分析法分析ChE与胰岛α细胞功能的相关性;使用多因素线性回归分析法分析ChE是否为胰岛α细胞功能的影响因素。结果共纳入502例T2DM患者。随着血清ChE水平的升高,BMI、HOMA-IR、GLA_(0)、GLA_(30)、GLA_(60)、GLA_(120)和AUC_(gla)水平逐渐升高(趋势P值<0.001),但HbA_(1c)在T_(1)、T_(2)和T_(3)三组间无明显变化趋势(P>0.05)。Pearson相关分析结果显示,血清ChE水平与GLA_(0)、GLA_(30)、GLA_(60)、GLA_(120)和AUC_(gla)明显相关(r=0.264、0.230、0.217、0.229、0.245,均P<0.001)。多因素线性回归分析结果显示,在校正了年龄、性别、BMI、血压、糖尿病病程、降糖药物、他汀类药物、肝功能指标、血脂�Objective To investigate the relationship between serum cholinesterase(ChE)levels and isletα-cell dysfunction in patients with type 2 diabetes mellitus(T2DM).Methods This was a cross-sectional study.T2DM patients were recruited for this study at the Department of Endocrinology of Nantong First People′s Hospital between July 2022 and December 2023.Anthropological parameters,including age,sex,blood pressure and body mass index(BMI)were collected.Duration of diabetes and the use of medications,including hypoglycemic agents and statins,were documented.Serum ChE,liver function indices,blood lipids,serum creatinine(SCr),uric acid(UA),cystatin C(CysC)and glycated hemoglobin A_(1c)(HbA_(1c))were measured in all patients.75 g oral glucose tolerance test was also performed to simultaneously detect glucose,insulin and glucagon(GLA)at fasting(0 min),30,60,120 and 180 min.Insulin resistance was assessed using the homeostasis model assessment of insulin resistance(HOMA-IR).Overall glucose levels after glucose load were evaluated by the area under the curve(AUC_(glu)).The indices of isletα-cell function included GLA_(0),GLA_(30),GLA_(60),GLA_(120)and overall glucagon levels after glucose load(area under the curve of glucagon,AUC_(gla)).All patients were divided into three subgroups according to the tertiles of serum ChE levels:group T_(1)(range of ChE,3.71-7.84 kU/L,167 patients),group T_(2)(range of ChE,7.85-9.44 kU/L,168 patients)and group T_(3)(range of ChE,9.45-17.94 kU/L,167 patients).One-way analysis of variance(ANOVA)with linear polynomial contrasts,the Jonckheere-Terpstra test,or theχ^(2)test with linear-by-linear association was used to analyze the trend of clinical data between subgroups.Pearson′s correlation analysis was used to analyze the relationship between ChE and isletα-cell function,and multivariate linear regression analysis was used to analyze whether ChE was an independent factor for isletα-cell function.Results A total of 502 eligible T2DM patients were recruited.From T_(1)to T_(2)to T_(3)of ChE,B

关 键 词：糖尿病 2型 胆碱酯酶 胰高糖素 胰岛Α细胞 胰岛素抵抗 

分 类 号：R587.1[医药卫生—内分泌]