胰岛β细胞分泌功能评估指标的比较——186例不同糖耐量者葡萄糖耐量试验资料分析

Comparison of various indexes for evaluating secretion of islet β-cell——clinical analysis of glucose tolerance test in 186 subjects with different glucose tolerance

目的探讨各种评估胰岛β细胞功能的指标在临床研究中应用的可行性。方法糖耐量正常(NGT)者70名、糖耐量受损(IGT)者56例及2型糖尿病(DM)患者60例参与本试验。各例均行静脉葡萄糖耐量试验和口服葡萄糖耐量试验。计算第一时相胰岛素分泌功能指数(AIR3-5、AIR0-10)、早期胰岛素分泌功能指数(ΔI30/ΔG30)、基础胰岛素分泌功能指数(HOMAβ)、修正的胰岛β细胞功能指数(MBCI)。分析在不同糖耐量组各胰岛β细胞功能指数的变化及相关性。结果NGT、IGT、2型DM患者的AIR3-5分别为(71.80±2.01)mU/L、(27.13±3.25)mU/L、(7.19±3.32)mU/L;ΔI30/ΔG30分别为(11.86±1.78)mU/mmol、(6.50±2.11)mU/mmol、(4.78±2.42)mU/mmol;AIR3-53组间比较均有统计学差异;而ΔI30/ΔG30在IGT及2型DM组间比较差异均无统计学意义,2型DM及IGT组低于NGT组,差异有统计学意义。AIR3-5、AIR0-10均能较好地区分出NGT、IGT、2型DM三者之间的差别,而ΔI30/ΔG30及MBCI不能区分出2型DM与IGT者之间的差别,HOMAβ则不能区分出IGT与NGT者之间的差别。结论在本研究人群中AIR是反映胰岛β细胞分泌功能相对较好的指标,ΔI30/ΔG30及MBCI也可用于临床上粗略评估胰岛β细胞功能。

Objective To evaluate the various methods of β-cell function analysis for their feasibility in clinical research. Methods Seventy subjects with normal glucose tolerance （NGT） , 56 patients with impaired glucose tolerance （IGT） and 60 patients with type 2 diabetes （DM） were recruited in the study. All subjects received intravenous glucose tolerance test and oral glucose tolerance test. First-phase insulin secretion index （AIR3-5 ,AIR0-10 ） , early insulin secretion index（ △I30/△G30 ） , basic insulin secretion index（HOMAβ） and modified β-cell function index（MBCI） were calculated. The variance and correlation of various islet β-cell function indexes in different groups were analysed. Results AIR3-5 of NGT, IGT, and type 2 DM were （71.8 ± 2.01 ） mU/L, （27. 13 ± 3.25 ） mU/L, （7.19 ± 3.32） mU/L, respectively. AI30/AG30 in NGT, IGT and type 2 DM were （ 11.86 ± 1.78） mU/mmol, （6.50 ± 2.11 ） mU/mmol and （ 4.78± 2.42） mU/mmol, respectively. There was significant difference in AIR3-5 among the three groups, while there were no difference in △I30/△G30 between IGT and type 2 DM with that of type 2 DM and IGT significantly lower than that of NGT （P 〈0.01 ）. AIR3-5, AIR0-10 reflected the difference of β-cell function among subjects with NGT, 1GT and type 2 DM, while △I30/△G30 and MBCI did not reflect the difference between subjects with type 2 DM and IGT, and HOMAβ did not reflect the difference between subjects with IGT and NGT. Conclusion AIR is a better parameter in evaluating β-cell function, while △I30/ △G30 and MBCI may approximately evaluate β-cell function.