危重症应激患者胰岛β细胞分泌第一时相组份的变化及分析

Changes and Significance of First Phase Insulin Secretion in Critically Ill Patients

目的:评价危重症应激患者的胰岛β细胞分泌功能。方法:将研究对象分为危重症应激高血糖组(A1组)、危重症应激非高血糖组(A2组)及健康对照组,观察并比较不同组间精氨酸刺激下的胰岛素分泌第一时相的真胰岛素、C肽、胰岛素原及免疫反应性胰岛素水平的变化。结果:A1组、A2组与健康对照组的精氨酸刺激下的真胰岛素第一时相均在6min内反映出各组的分泌状态,各组分泌曲线基本一致,其空腹真胰岛素分别为93.59±8.97mU/L,63.38±33.57mU/L及73.53±29.35mU/L。各组均在2min达到其峰值浓度;各组AUC(曲线下面积)及空腹真胰岛素差异无显著性。A1组存在着明显的胰岛素抵抗。胰岛素分泌第一时相中C肽浓度的分泌曲线与胰岛素分泌同步,各组C肽浓度也在2min达到分泌峰值。A1组、A2组高峰稍提前。A1组空腹C肽浓度,分泌峰值浓度及AUC与A2组及健康对照组差异均具有显著性。结论:危重症应激高血糖与应激非高血糖患者之间在静脉注射精氨酸刺激下第一时相的真胰岛素分泌存在明显的差别;危重症应激高血糖患者的胰岛素分泌第一时相的特征是分泌峰值增高,分泌时限缩短,分泌组份中C肽,胰岛素原出现异常;危重症应激高血糖患者存在着明显的胰岛素抵抗。

Objective：To evaluate the pancreatic islet β cell secretion function of the critically ill patients. Method： All the samples studied were divided into critically ill patients with hyperglycemia group （A1 group）, critically ill patients without hyperglycemia group （A2 group） and healthy control group. Levels of true insulin, C peptide of the first phase secretion stimulated by Larginine were observed and compared among the groups. Results： The state of first phase true insulin response to Larginine were reflected within 6 minutes in A1, A2 and control group. The secretion curve of the each group was coincidence on the whole. Levels of fasting true insulin were 93.59 ± 8. 97m U/L, 63.38 ± 33. 57 mU/L and 73.53± 29. 35 mU/L respectively. The concentration reached its peak at the point of the 2 minutes in each group, the difference of the area under curve of first phase true insulin response of the A1 group, A2 group and control group was not significant. There was obvious insulin resistance in A1 group. The first phase response of C peptide was as at equal pace as insulin. The peaks of C peptide curve of the A1, A2 groups were slightly ahead of schedule. Concerntration of fasting C-peptide, secretion peak value and AUC in A1 group were significantly different compared with those of A2 group and control group. Conclusion： The First phase true insulin response stimulated by L-arginine between critically ill patients with hyperglycemia and critically ill patients without hyperglycemia is significantly different. The increased peak value of the secretion is the characteristic of the first phase insulin response in the crtitally ill patients with stress hyperglycemia, the secretion time is shortened, C peptide and proinsulin are abnormal. The critically ill patients with stress hyperglycemia present apparent insulin re sistance.