糖尿病酮症和酮症酸中毒患者胰岛β细胞功能改变的初步观察

Changes of islet β cell function in patients with diabetic ketosis and ketoacidosis

用 L-精氨酸(L-ARG)或葡萄糖(GLU)刺激法,对42例发病年龄25岁～39岁之间的糖尿病酮症(DK)和酮症酸中毒(DKA)患者的胰岛β细胞功能和临床特点进行分析。结果:①胰岛β细胞对 L-ARG 刺激虽有一定的反应性,但胰岛素(Ins)和 C 肽分泌峰值明显低于正常人,随病程延长逐渐降低;经良好控制血糖和其它代谢紊乱后,Ins 和 C 肽分泌峰值有所提高。GLU 胰岛β细胞刺激反应明显减弱,治疗后也无明显提高;②病程>3个月的患者空腹血 Ins 与正常人无显著性差异,L-ARG 刺激后 C肽分泌峰值低于 Ins 的增加幅度。结果提示:发病年龄在25岁～39岁之间的 DM 患者,在疾病早期胰岛β细胞就存在分泌功能障碍,随病程的延长而加重,治疗应以外源 Ins 为主,L-ARG 刺激法有助于判定胰岛β细胞的功能状况。

The islet secretion function in 42 clinically diagnosed diabetic ketosis and ketoacidosis pa- tients,aged 25～39 year-old,were studied.The results showed that the acute insulin responses to L-ARG (AIRarg) was significantly reduced in patients compared to control.As disease prolonged,AIRarg de- creased gradually.In the patients less than three months,the acute insulin responses to glucose(AIRglu) were markedly reduced,although the AIRarg were still sustained to some extent.The fasting blood insulin levels,in the patients more than three months were not different from controls,but C-peptide levels were significantly lower than those of controls.However,the C-peptide responses to L-ARG stimulation were not as evident as the insulin responses.The results suggested that impairment of the insulin secretion exist of in the early stage of DM,and exaggerated as the disease prolonged.Terapy of this type of diabetes mellitus de- pended mainly on insulin.