2型糖尿病患者胰岛β细胞功能与甲襞微循环状态的关系  

Relationship between isletβcell function and nailfold microcirculation in type 2 diabetes mellitus patients

作　　者：韩雨萌 袁诗沁 胡蕴 许岚 HAN Yumeng;YUAN Shiqin;HU Yun;XU Lan(Department of Endocrinology,The Affiliated Wuxi People's Hospital of Nanjing Medical University,Wuxi 214023,China)

机构地区：[1]南京医科大学附属无锡人民医院内分泌科,江苏无锡214023

出　　处：《山东医药》2024年第26期31-35,共5页Shandong Medical Journal

基　　金：江苏省研究生科研与实践创新计划项目(SJCX23_0687)。

摘　　要：目的探讨2型糖尿病(T2DM)甲襞微循环特征及其与胰岛β细胞功能的相关性。方法选择126例T2DM患者,采集患者空腹静脉血,采用己糖激酶终点法检测空腹血糖(FPG),电化学发光免疫分析法检测空腹胰岛素(FINS)和空腹C肽(FCP),根据FPG、FINS、FCP计算胰岛β细胞功能指数(HOMA2-%B)。根据HOMA2-%B中位数将患者分为高HOMA2-%B组和低HOMA2-%B组。使用甲襞毛细血管镜(NFC)采集毛细血管图像,检测毛细血管密度和毛细血管直径,观察甲襞毛细血管异常情况并对其进行评分。采用Spearman相关分析HOMA指数与甲襞微循环指标的相关性,采用多因素线性回归分析HOMA2-%B的影响因素。结果与高HOMA2-%B组相比,低HOMA2-%B组毛细血管密度增加,分支毛细血管减少(P均<0.05),两组毛细血管直径及NFC评分比较差异均无统计学意义(P均>0.05)。T2DM患者分支毛细血管与HOMA2-%B呈正相关(r=0.206,P<0.05),毛细血管密度、奇异毛细血管与HOMA2-%B呈负相关(r分别为-0.252,-0.234,P<0.01)。分支毛细血管形态减少、毛细血管密度增加与T2DM患者HOMA2-%B降低有关(P均<0.05)。结论T2DM患者甲襞微循环与胰岛β细胞功能存在相关性,其中分支毛细血管形态减少与密度增加提示胰岛β细胞功能可能进一步下降。Objective To explore the characteristics of nailfold microcirculation in type 2 diabetes mellitus(T2DM)and its correlation with isletβcell function.Methods Totally 126 patients with T2DM were selected.Fasting venous blood was collected from patients,and fasting plasma glucose(FPG)was measured by hexokinase endpoint method,fasting insulin(FINS)and fasting C-peptide(FCP)were measured by electrochemiluminescence immunoassay,and pancreaticβ-cell function index(HOMA2-%B)was calculated.Based on HOMA2-%B median,we divided the patients into high HOMA2-%B group and low HOMA2-%B group.Nailfold capillaroscopy(NFC)was performed to collect the image of nailfold microcirculation,to detect capillary density and capillary diameter,and to observe the abnormalities of nailfold capillaries and to score it.Spearman correlation was used to analyze the correlations between HOMA index and nailfold microcirculation indexes,and multifactorial linear regression was used to analyze the influencing factors for HOMA2-%B.Results Compared with those with high HOMA2-%B,branching capillaries were reduced and the density increased in those with low HOMA2-%B(all P<0.05).There were no statistically significant differences in the capillary diameter and NFC score between the two groups(all P>0.05).Branching capillaries were positively correlated with HOMA2-%B(r=0.206,P<0.05).The density of nailfold capillaries and bizarre capillaries were negatively correlated with HOMA2-%B(r=–0.252 and–0.234,both P<0.01).Multifactorial regression analysis showed that decreased branching capillary morphology,increased capillary density,and increased HbA1c were associated with the decrease of HOMA2-%B in patients with T2DM(both P<0.05).Conclusion There is a correlation between the nailfold microcirculation and isletβcell function in patients with T2DM,and their decreased branching capillary morphology and increased capillary density suggest that pancreatic function may be further reduced.

关 键 词：2型糖尿病 胰岛Β细胞功能 甲襞微循环 甲襞毛细血管镜 

分 类 号：R587.1[医药卫生—内分泌]