胰岛素释放试验和胰岛素样生长因子-Ⅰ检测在2型糖尿病诊断和治疗中的应用

Application of insulin releasing test and insulin-like growth factor-Ⅰ in diagnosis and treatment of type Ⅱ diabetes mellitus

目的:探讨胰岛素释放试验(IRT)及胰岛素样生长因子-Ⅰ(IGF-Ⅰ)水平检测在2型糖尿病(T2DM)诊断和治疗中的价值,阐明两者之间的关系。方法:选择T2DM患者138例,依据空腹胰岛素水平分为T2DMA类(空腹胰岛素值低于正常,餐后释放反应低、峰时延迟)59例,T2DM B类(空腹胰岛素值正常或高于正常值,餐后释放反应高、峰时延迟)79例,另选43例健康体检者作为健康对照组。检测患者服药(口服25%葡萄糖溶液300 mL)后不同时间血糖、胰岛素及空腹IGF-Ⅰ水平。结果:T2DM A类患者空腹胰岛素水平低,服药后与同时间对照组比较胰岛素水平降低(P<0.05),服药后胰岛素峰值也较低(P<0.05),高峰值后延30～60 min,180 min仍保持较高值(P<0.05),其IGF-Ⅰ低于对照组和T2DM B类患者(P<0.05);T2DM B类患者空腹胰岛素值高于正常对照组,服药后高峰出现较晚,后延60～120 min,峰值与对照组接近(P>0.05),180 min时仍保持较高值,其IGF-Ⅰ高于对照组和T2DM A类患者(P<0.05)。结论:IRT及IGF-Ⅰ能较好地反映人体内降糖途径的功能状况,两者结合分析对于T2DM的诊断和治疗有重要的应用价值。

Objective To investigate the value of insulin releasing test（IRT） and insulin-like growth factor-Ⅰ（IGF-Ⅰ） in diagnosis and treatment of type Ⅱ diabetes mellitus（T2DM） and clarify the relationship between them.Methods 138 T2DM patients（59 T2DM A and 79 T2DM B） and 43 cases of healthy controls were chosen.The blood glucose,insulin at different time and fasting IGF-Ⅰ were measured.Results The level of fasting insulin in T2DM patients was lower than that in control group at the same time（P0.05）,the peak of insulin was lower also（P0.05） and was delayed for 30-60 min,it still contained a higher level at 180 min（P0.05）,the IGF-Ⅰ level were lower than those in control group and T2DM B patients（P0.05）.The level of fasting insulin was higher than that in control group,the peak was delayed for 60-120 min,the peak value was similar to control group（P0.05） and stayed higher level till 180 min;The IGF-Ⅰ level was higher than those in control group and T2DM A patients（P0.05）.Conclusion IRT and IGF-Ⅰ can obviously show the state of glucose metabolism.IRT combined with IGF-Ⅰ play an important role in diagnosis and treatment of T2DM.