痛风病人胰岛β细胞分泌功能的研究

AN ANALYSIS OF BETA-CELL FUNCTION IN PATIENTS WITH GOUT

目的探讨痛风病人胰岛β细胞分泌功能的变化。方法选取2011年1—6月在我院门诊及住院的初诊痛风病人76例(单纯性痛风39例和痛风并发糖尿病前期37例)及同期来我院健康体检的正常对照30例(正常组),测定空腹血尿酸(UA)、空腹血糖(FPG)、血脂、肾功能、空腹胰岛素(FINS)及左旋精氨酸兴奋后2、4、6min胰岛素的水平,次日行口服75g葡萄糖耐量试验(OGTT),测定服糖后30、60、120min血糖、胰岛素的水平。结果痛风组与正常组比较,体质量指数(BMI)、腰围、FPG、120min血糖、FINS、胰岛素抵抗指数(HOMA-IR)、血UA、肌酐、尿素氮、胆固醇(TC)、三酰甘油(TG)明显升高(t=2.245～12.032,P<0.05)。精氨酸刺激后胰岛素分泌正常组胰岛素分泌均在2min达峰值,痛风组27.6%的病人在4～6min达峰值(χ2=10.337,P<0.05);痛风组分泌峰值高于正常组(t=2.538,P<0.05);痛风组胰岛素分泌曲线下面积(AUC)>正常组(t=2.806,P<0.05);正常组峰值升高倍数>痛风组(t=4.523,P<0.05)。葡萄糖刺激后胰岛素分泌正常组胰岛素分泌均在30～60min达峰值,痛风组67.1%的病人在30～60min达峰值(χ2=16.86,P<0.05);痛风组分泌峰值高于正常组(t=5.521,P<0.05);痛风组胰岛素分泌AUC>正常组(t=6.179,P<0.05)。单纯性痛风组17.9%病人OGTT胰岛素分泌在120min达峰值,痛风并发糖尿病前期组48.6%病人在120min达峰值(χ2=8.860,P<0.05)。BMI、腰围、UA与胰岛β细胞分泌功能相关(t=2.646～4.479,P<0.05)。结论痛风病人胰岛β细胞分泌功能代偿性增高,第一时相胰岛素分泌峰值升高倍数下降,胰岛β细胞第一和第二时相分泌均延迟,痛风并发糖尿病前期病人第二时相分泌延迟更为明显。

Objective To explore the changes of islet β-cell function in patients with gout. Methods Seventy-six pa- tients with gout were recruited in this study, who were confirmed the diagnosis in our hospital during January-June, 2011. Of whom, 39 with normal blood glucose, and 37 complicating prediabetes. A control group consisted of 30 healthy persons. Fasting blood glucose, uric acid, blood fat, renal function, insulin, and insulin level after 2, 4 and 6 rain stimulation with L-arginine. The next day, an oral glucose tolerance test （OGTT, 75 g of glucose） was conducted, the blood glucose and insulin levels were meas- ured at 30, 60 and 120 rain after taking the glucose. Results Compared with normal control group, the body mass index （BMI）, waist circumference, fasting glucose, 1Z0-min glucose of OGTT, fasting insulin, HOMA-IR, blood UA, creatinine, urea nitrogen, TC, TG, in gout group were significantly elevated （t = 2. 245-12. 032, P〈0.05）. After stimulation with L-arginine, the insulin secretion in normal insulin secretion group reached its peak in 2 min; in gout group, 27.6% reached its peak in 4--6 min （χ^2=10. 337,P〈0. 05）; the peak value in gout group was higher than that in normal group （t=2. 538,P〈0.05） ~ Insulin secre- tion area under curve （AUC）：~normal group （t=2. 806,P〈0.05） the multiple of elevation of the peak value in normal group：〉 gout group （t=4. 523,P〈0.05）. After stimulation by glucose, in normal insulin-secretion group, all of the subjects reached the peak value in 30-60 rain, and in gout group, only 67.1% of the patients reached the peak （χ^2 =16.86,P〈0.05）. The peak value of secretion in gout group was higher than that in normal group （t = 5. 521, P〈0.05）, and AUC ：〉normal group （t = 6. 179, P〈 0.05）. In OGTT, 17.9 of the patients without complications reached the peak of insulin secretion in 120 min, and those compli- cating prediabetes, 48.60% （χ^2=8. 860, P〈0.05）. BMI, waist circumference and UA were positively correlated with the secretory function of beta cell of islet （t= 2. 646-4. 479, P〈0.05）. Conclusion Islet β-cell function increases compensatively in uratic patients, the multiples of the peak level of insulin secretion in the first phase decline, the time of peak delays significantly in thefirst and second phase. In those complicating prediabetes, the delay of secretion in the second phase is more obvious.