精氨酸刺激试验在不同糖耐量人群中的临床应用  

Clinical application of arginine stimulation test in individuals with different glucose tolerance

作　　者：赵静 尹江宁 彭易根 张士卿 ZHAO Jing;YIN Jiangning;PENG Yigen(Department of Emergency Medicine,Nanjing Jiangning Hospital,Jiangsu,Nanjing 211100,China)

机构地区：[1]江苏省南京市江宁医院急诊内科,211100

出　　处：《河北医药》2024年第24期3731-3735,共5页Hebei Medical Journal

基　　金：江苏卫生健康职业学院科研项目(编号:JKC202010)。

摘　　要：目的探讨精氨酸刺激试验(AST)中不同糖耐量人群胰岛β细胞功能的变化并建立指导2型糖尿病患者选择胰岛素治疗的切点。方法选取2018年1月至2020年1月糖尿病患者及健康人群120例,分为5组:糖耐量正常者22例(NGT组)、糖耐量受损者17例(IGT组)、单纯口服降糖药物治疗的2型糖尿病患者21例(T2DM a组)、胰岛素治疗的2型糖尿病患者30例(T2DM b组)和1型糖尿病患者30例(T1DM组),均行AST,分别测定0、2、4、6 min静脉血中血糖(PG)、胰岛素(INS)、C肽(CP)水平。结果空腹INS/PG、CP/PG在T2DM b组、T1DM组显著低于NGT组(P<0.05),且T2DM b组显著低于T2DM a组(P<0.05)。5组INS/PG和CP/PG均在2 min达峰值。与NGT组相比,T2DM a组、T2DM b组、T1DM组INS/PG峰值/基础值显著降低(P<0.05),且T1DM组显著低于IGT组(P<0.05)。2、4、6 min INS/PG、CP/PG在T2DM a组、T2DM b组、T1DM组显著低于NGT组(P<0.05),在T2DM b组、T1DM组显著低于IGT、T2DMa组(P<0.05)。T2DM b组、T1DM组ΔINS、ΔCP、ΔINS/PG、ΔCP/PG、AUCINS、AUCCP、AUCINS/PG、AUCCP/PG均显著低于NGT组、IGT组、T2DM a组(P<0.05)。与NGT组相比,IGT组、T2DM b组、T1DM组HOMA-β显著降低(P<0.05)。T2DM患者选择胰岛素治疗的切点以AUCCP/PG、AUCCP最优,其切点值分别为164.0和5995.1。结论AST可用于评估不同糖耐量人群胰岛β细胞功能,其中ΔINS、ΔINS/PG、AUCINS/PG和AUCCP/PG可较好地评价胰岛β细胞功能。此外,AST可有效地指导T2DM患者选择胰岛素治疗的时机,其判定指标中以AUCCP/PG和AUCCP为佳。Objective To investigate the changes in isletβ-cell function in individuals with different glucose tolerance during the arginine stimulation test(AST)and to establish the cut-off points for guiding the insulin treatment in patients with type 2 diabetes mellitus(T2DM).Methods A total of 120 diabetic patients and healthy people admitted from January 2018 to January 2020 were included,involving 22 subjects with normal glucose tolerance(NGT group),17 subjects with impaired glucose tolerance(IGT group),21 T2DM patients only treated with oral hypoglycemic agents(T2DMa group),30 T2DM patients treated with insulin(T2DMb group)and 30 subjects with type 1 diabetes mellitus(T1DM group).All of them were received AST.Plasma glucose(PG),insulin(INS)and C-peptide(CP)concentrations at 0,2,4 and 6min were measured.Results Fasting INS/PG,CP/PG in T2DMb and T1DM groups were significantly lower than those of the NGT group(P<0.05),and they were significantly lower in the T2DMb group than the T2DMa group(P<0.05).INS/PG and CP/PG in all groups reached the peak at 2 min.The peak/baseline ratio of INS/PG in T2DMa,T2DMb and T1DM groups was significantly lower than that of the NGT group(P<0.05),and it was significantly lower in the T1DM group than the IGT group(P<0.05).Compared with NGT group,T2DMa,T2DMb and T1DM groups had significantly lower INS/PG and INS/PG at 2,4,and 6min,and those in T2DMb and T1DM groups were significantly lower than IGT and T2DMa groups(P<0.05).T2DMb and T1DM group had significantly lowerΔINS,ΔCP,ΔINS/PG,ΔCP/PG,AUCINS(insulin area under the curve),AUCCP(C-peptide area under the curve),AUCINS/PG and AUCCP/PG than NGT,IGT and T2DMa groups(P<0.05).IGT,T2DMb and T1DM groups had significantly lower homeostatic model assessment for beta-cell function(HOMA-β)than the NGT group(P<0.05).The optimal cut-off points of AUCCP/PG and AUCCP for guiding insulin treatment in T2DM patients were 164.0 and 5995.1,respectively.Conclusion The arginine stimulation test can be used to estimateβ-cell function in individuals with dif

关 键 词：精氨酸刺激试验 胰岛Β细胞 糖尿病 糖耐量受损 

分 类 号：R587.1[医药卫生—内分泌]