新诊断2型糖尿病患者糖化血清白蛋白水平与胰岛β细胞功能的关系

Relationship between glycated albumin level and pancreatic 13 cell function in newly diagnosed type 2 diabetics

目的探讨新诊断2型糖尿病患者糖化血清白蛋白（GA）与胰岛B细胞功能的关系。方法研究对象来自于2008年1月至2010年10月为明确糖尿病（DM）诊断而就诊者和DM高危人群接受筛查者，受检者均行75g口服葡萄糖耐量试验（OGTT）及胰岛素释放试验，采用液态酶法测定GA水平，采用高压液相法测定糖化血红蛋白（HbA1c）水平。以稳态模式分析法（HOMA）评价基础胰岛素抵抗（HOMA-IR）和胰岛B细胞分泌功能（HOMA-β）；以胰岛素增量与葡萄糖增量比值（A130／AG30）评估糖负荷后早期相胰岛素分泌。结果（1）按1999年WHO糖尿病诊断标准，经OGTr诊断为2型DM的500例患者中，男279例、女221例。平均年龄（56．3±12．3）岁，GA为（21．1±5．4）％，HbA1c为（7．0±1．3）％，HOMA—B为（男：984-63）％（女：1214-80）％。（2）GA与HbA1c之间有良好的相关性（r=0．691，P〈0．01）。GA与OGTF中空腹血糖（FPG），糖负荷后0．5、1、2和3h的各点血糖均呈正相关（r值为0．511～0．627，均P〈0．01）。（3）GA与体质指数呈负相关（r=-0．112，P〈0．01）。GA与HOMA-B、A130／AG30呈负相关（r值分别为一0．350、一0．263，均P〈0．01）。（4）多元逐步回归分析，显示HbA1c、FPG、糖负荷后3h血糖及A130／AG30是影响GA的主要因素。结论新诊断2型DM患者GA水平与早期相胰岛素分泌功能密切相关。

Objective To explore the relationship between glycated albumin （GA） level and pancreatic β cell function in newly diagnosed type 2 diabetics. Methods The subjects sought the confirmation of diabetes diagnosis or underwent diabetes screening tests in high-risk patients from January 2008 to October 2010. All of them underwent 75 g oral glucose tolerance test （OGTT） and insulin releasing test. The levels of GA and hemoglobin A1c （HbA1c ） were analyzed by liquid enzymatic method and high performance liquid chromatography respectively. Homeostasis model assessment （HOMA） was used to evaluate the basal insulin resistance （HOMA-IR） and pancreatic β cell function （HOMA-13）. △I30/AG30 was used to evaluate early-phase insulin secretion after a glucose load. Results （ 1 ） Among 500 type 2 diabetics according to the diagnostic criteria of WHO （1999）, 279 were males and 221 were females. Average age was56.3 ±12.3, GA （21.1±5.4）% and HbAlc （7.0 ±1.3）%. （2） A significantly positive relationship was shown between HbAlc and GA （ r = 0. 691, P 〈 0.01 ）. GA was also positively correlated with fasting plasma glucose （ FPG）, 0. 5 hPG, 1 hPG, 2 hPG and 3 hPG after a glucose load of OGTY test （ r = 0. 511 - 0. 627, P 〈 0. 01 ）. （ 3 ） GA was negatively correlated with body mass index （BMI） （r = - 0. 112, P 〈 0. 01 ） , HOMA-I3 （ r = - 0. 350, P 〈 0. 01 ） and △I30/AG30 （ r = - 0. 263, P 〈 0.01）. （4） Muhivariant stepwise regression analysis showed that HbAlc, FPG, 3 hPG and △I30/AG30 were independent factors of GA level. Conclusion Glycated albumin level is closely correlated with the function of early-phase insulin secretion in newly diagnosed type 2 diabetics.