胰岛素对2型糖尿病患者胰岛A细胞分泌功能的影响

Effects of Insulin Therapy on Pancreatic Islet A-cell Function in patients with Type 2 Diabetes

目的探讨胰岛素对2型糖尿病患者胰岛A细胞的分泌功能的影响。方法 2型糖尿病患者44例、健康体检者15例,其中44例糖尿病患者按治疗前空腹C肽水平分成低水平C肽组(D1)、中等水平C肽组(D2)、高水平C肽组(D3)。测定受试者晨间空腹血糖、胰岛素、C肽、胰高血糖素。糖尿病各组给予预混人胰岛素诺和灵30R替代治疗,根据血糖水平调节胰岛素用量,使用4周后停药24h后复查上述指标,观察治疗前后各指标的变化。结果①胰岛素治疗前糖尿病各组胰高血糖素水平均显著高于正常对照组(P<0.05)。②经胰岛素治疗4周后,糖尿病各组血浆胰高血糖素水平均下降,其中D1、D2组下降明显(P<0.05),而D3组下降不显著(P>0.05)。③治疗后糖尿病组3组间的胰高血糖素值差异不明显(P>0.05)。④糖尿病各组的治疗后的胰高血糖素值与对照组差异不显著(P均>0.05)。结论①外源性胰岛素的治疗可改善A细胞的分泌异常,部分纠正高胰高血糖素血症。②胰岛素治疗的尽早使用有利A细胞分泌异常的恢复。

Objective To study effects of insulin therapy on pancreatic islet A-cell secretion function in patients with type 2 diabetes mellitus.Method 44 T2DM patients and 15 healthy persons were tested for FPG,fasting insulin,C-peptide,glucagons.The 44 T2DM patients are divided into 3 groups according to the level of C-peptide：low level C-peptide（D1）,media C-peptide（D2）,high level C-peptide（D3）.Premixed 30% regular,70% human neutral protamine hagedorn insulin（70/30） is given to the T2DM patients group and the dosage is adjusted by the blood glucose.Continue to use insulin for 4 weeks after glucostasis are reached.Test the above each index after they had stopped using insulin for 24 hours.Compare the change of every index before and after the treatment.Results ①Before the insulin therapy,in each T2DM patient group,the level of glucagons is significantly higher than the control group（P0.05）.②Compared with non-insulin-therapy,with insulin therapy for 4 weeks in each T2DM patient group the level of glucagons all decreased,in D1、D2 group the level of glucagons significantly decreased（P0.01）,in D3 group the level of glucagons decreased unsignificantly（P0.05）.③ After the insulin therapy,there is no significant difference in the level of glucagons between each diabetic group（P0.05）.④After the insulin therapy,the level of glucagons of three groups are higher than the control group,but no significant difference（P0.05）.Conclusion ①The exogenous insulin therapy could improve the secretion of A-cell,partly control the high blood glucagons.②The earlier insulin therapy using,the better the secretion of A-cell recovery.