2型糖尿病患者胰岛α及β细胞功能与尿白蛋白/肌酐比值的相关性分析  

Relationship between isletαandβcell function and urinary albumin-to-creatinine ratio in patients with type 2 diabetes mellitus

作　　者：郭航[1] 王娟[1] 刘向阳 孙蓓[3] 陈莉明[4] Guo Hang;Wang Juan;Liu Xiangyang;Sun Bei;Chen Liming(National Health Commission Key Laboratory of Hormones and Development,Tianjin Key Laboratory of Metabolic Diseases,Department of Integrated Traditional Chinese and Western Medicine,Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology,Tianjin Medical University,Tianjin 300134,China;Blood Purification Center,Chu Hsien-I Memorial Hospital,Tianjin 300134,China;Department of Teaching and Research,Chu Hsien-I Memorial Hospital,Tianjin 300134,China;Chu Hsien-I Memorial Hospital,Tianjin 300134,China)

机构地区：[1]天津医科大学朱宪彝纪念医院中西医结合科、天津市内分泌研究所、国家卫健委激素与发育重点实验室、天津市代谢性疾病重点实验室,天津300134 [2]天津医科大学朱宪彝纪念医院血液净化中心,天津300134 [3]天津医科大学朱宪彝纪念医院科教科,天津300134 [4]天津医科大学朱宪彝纪念医院,天津300134

出　　处：《中华糖尿病杂志》2025年第3期329-334,共6页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：国家自然科学基金面上项目(82370842);国家自然科学基金青年项目(82305007);天津市医学重点学科(专科)建设项目(TJYXZDXK-032A)。

摘　　要：目的探讨不同尿白蛋白/肌酐比值(UACR)水平与2型糖尿病(T2DM)患者胰岛α、β细胞功能的相关性。方法为横断面研究。纳入2018年3月至2023年10月于天津医科大学朱宪彝纪念医院住院的T2DM患者458例,按UACR水平分为3组:正常白蛋白尿组(UACR<30 mg/g),微量白蛋白尿组(30 mg/g≤UACR≤300 mg/g)和大量白蛋白尿组(UACR>300 mg/g)。测量身高、体重、血压,计算体重指数(BMI)。检测糖化血红蛋白(HbA1c)、空腹血糖(FPG)、估算的肾小球滤过率(eGFR)等。所有研究对象行口服葡萄糖耐量试验(OGTT)并于空腹及口服75 g葡萄糖后30、60、120、180 min检测血糖、胰岛素、C肽和胰高糖素,计算其稳态模型评估胰岛素抵抗指数(HOMA-IR)、稳态模型评估胰岛β细胞功能指数(HOMA-β)、胰高糖素曲线下面积(AUCG)、胰岛素曲线下面积(AUCI)、胰岛素敏感性指数(ISI)、早期胰岛素分泌指数(ΔI30/ΔG30)、葡萄糖处置指数(DI)。资料分析采用重复测量数据的方差分析,多组间比较采用单因素方差分析,采用Pearson相关分析法分析胰高糖素及UACR和相关指标间的相关性,多元逐步回归分析法分析UACR的影响因素。结果共纳入T2DM患者458例,其中正常白蛋白尿组184例,微量白蛋白尿组161例,大量白蛋白尿组113例。与正常白蛋白尿组相比,微量白蛋白尿组及大量白蛋白尿组各时间点胰高糖素水平,AUCG及胰高糖素/胰岛素比值均升高(P<0.05)。葡萄糖负荷后胰高糖素高峰从60 min延迟到120 min。与正常白蛋白尿组相比,微量白蛋白尿组、大量白蛋白尿组HOMA-IR明显升高,ISI明显下降(P<0.05)。与正常白蛋白尿组、微量白蛋白尿组相比,大量白蛋白尿组AUCI升高,DI水平下降(P<0.05)。Pearson相关分析结果显示,胰高糖素与eGFR、BMI、ISI呈负相关(r值分别为-0.229、-0.153、-0.144,均P<0.05),与FPG、AUCG、HbA1c、UACR、病程呈正相关(r值分别为0.549,0.476,0.275,0.216,0.193,均P<0.05);UAObjective To explore the correlation between different urine albumin-to-creatinine ratios(UACR)and the function of pancreaticαandβcells in patients with type 2 diabetes mellitus(T2DM).Methods This cross-sectional study included 458 T2DM patients,who were admitted to Tianjin Medical University Chu Hsien-I Memorial Hospital from March 2018 to October 2023.Patients were divided by their UACR into normal albuminuria group(UACR<30 mg/g),microalbuminuria group(30 mg/g≤UACR≤300 mg/g),and macroalbuminuria group(UACR>300 mg/g)according to their UACR.Height,weight and blood pressure were measured,and body mass index(BMI)was calculated.Glycated hemoglobin A 1c(HbA 1c),fasting plasma glucose(FPG),estimated glomerular filtration rate(eGFR)and other data of the patients were detected.All patients underwent an oral glucose tolerance test(OGTT)and had their blood glucose,insulin,C-peptide,and glucagon levels measured at fasting and 30,60,120,and 180 minutes after taking orally 75 g of glucose.The homeostatic model assessment for insulin resistance(HOMA-IR)andβ-cell functions(HOMA-β)were calculated.Meanwhile,areas under the curve of glucose(AUC G),areas under the curve of insulin(AUC I),the insulin sensitivity index(ISI),the early insulin secretion index(ΔI30/ΔG30),and the glucose disposal index(DI)were calculated.Repeated measures ANOVA was adopted for data analysis.One-way analysis of variance(ANOVA)was used for comparisons among different groups.Pearson correlation analysis was employed to examine the relationship between glucagon levels and UACR with related indices.Multiple stepwise regression analysis was used to analyze the influencing factors of UACR.Results A total of 458 T2DM patients were included,with 184 in the normal albuminuria group,161 in the microalbuminuria group,and 113 in the macroalbuminuria group.Compared with the normal albuminuria group,microalbuminuria and macroalbuminuria groups had higher glucagon levels,larger AUC G values and glucagon/insulin ratios at all tested time points(P<0.05).The pea

关 键 词：糖尿病 2型 糖尿病肾病 尿白蛋白/肌酐比值 胰高糖素 胰岛Α细胞 胰岛Β细胞 

分 类 号：R587.1[医药卫生—内分泌]