用诺和龙试验评价糖尿病患者胰岛β细胞功能应用

Investment of the Repaglinide Stimulate Test in Estimating Islet β Cell Function in Individuals with Different Abnormalities of Glucose Metabolism.

目的:本研究拟在探讨诺和龙试验能否临床用于评价胰岛β细胞,以替代D860胰岛素释放试验。方法:分别检测662例2型糖尿病患者空腹及口服诺和龙后30min,60min,120min及180min的血糖,胰岛素水平的变化(应用外源性胰岛素的患者,检测C肽水平),结果:(1)在NT2DM与PT2DMA组F1NS/FPG水平明显高于T1DM与PT2DMC组,差异有统计学意义(P<0.05),但空腹C肽及C肽/空腹血糖在各组间差异无统计学意义。(2)口服诺和龙2毫克后,PT2DMC组没有胰岛素及C肽的快速分泌,其余各组在口服诺和龙后,胰岛素水平,胰岛素/血糖(I/PG)水平均在30min达到高峰,峰值在NT2DM,PT2DMA显著高于T1DM及PT2DMC组(P<0.01)。(3)口服诺和龙后30min胰岛素/血糖增值(△I30/△P30),胰岛素曲线下面积(AUCl),血糖校正后的胰岛素曲线下面积(AUCI/P),3h胰岛素净增值(△I/PG),HOMAβ,胰岛β细胞功能指数(MBCl),胰岛素抵抗指数(Homar-IR),胰岛素敏感指数(IAI)在NT2DM组明显高于T1DM及PT2DMC组(均P<0.05),同时,HOMAβ,△I30,AUCI,ACCI/P及△I/PG在PT2DMA组明显高于T1DM及PT2DMC组(P<0.05),△I30,AUCI,△I/PG在NT2DM组及T2DMB组之间也有显著性差异,(P<0.01)。结论:(1)诺和龙实验可以用来评估不同糖代谢紊乱状态人群胰岛β细胞功能,特别是空腹血糖明显升高的10年之内的2型糖尿病患者胰岛β细胞功能。(2)诺和龙口服后△I30/△P30,AUCI,ACCI/P,△I/P,HOMAβ,MBCI,Homar-IR,IAI均可以作为评价胰岛β细胞功能的指标,其中以HOMAβ,△I30,AUCI,ACCI/P及△I/PG为佳。

Objective ： to investigate the possibility of the Repaglinide stimulate test to estimateislet β cell function in individuals with different abnormalities of glucose metabolism. Methods： serum blood glucose （PG）, insulin（I） and c- peptide were measured at 0,30,60,120,180 minutesafter 2 mg Repaglinide received in 662 individuals, including 59 with type 1 diabetes（ T1 DM）, 130 with newly diagnosed type 2 diabetes（ NT2DM）, 235 with diagnosed type 2 diabetes with in 5years（ PT2DMA）, 164 with diagnosed type 2 diabetes within 10 years（PT2DMB） and 74 diagnosed type 2 diabetes more than 10 years （FIEDMC）. Result： （1） the fasting values of FINS/FPG in NT2DM and FF2DMA were higher than T1DM and PT2DMC （P 〈 0.05 ）, the difference in the fasting values of e - peptide and CP/PG show no statistical signifieances （P 〉 0.05）. （2） After received 2mg Repaglinide, the insulin secretion in PT2DMC were nearly or totally absent,the values of insulin and I/PG were at the peak at 30 minutes after2mg Repaglinide received, and the peak were lower in T1DM and PT2DMC than those in NT2DM and PT2DMA（P 〈0.01 ）. （3） the differences in the values of A I30/A P30, AUCI,AUCI/P, A I/PG, HOMA 13 ,MBCI, Homar-IR, IAI among NT2DM, T1DM, PT2DMC had statistical significance（all P 〈 0.05 ） . Conclusion：（ 1 ） the Repaglinide stimulate test can be used to estimate 13 cell secretary capacity in individuals with different abnormalities of glucose metabolism especially in type 2 diabetes within 10 years individuals with the fasting blood glucose higher than 10 mmol/l. （2）The △I30/△P30, AUCI, ACCI/P, △I/P, HOMA 13,MBCI, Homar-IR, IAI values after Repaglinide stimulation may be used as predictors for islet β call function in clinical practice , of which HOMA β, △I30, AUCI, ACCI/P and △I./PG parameters appear to be more valuable.