初诊2型糖尿病患者短期胰岛素泵强化治疗后血清γ谷氨酰转移酶水平的变化

Change of serum gamma-glutamyltransferase in newly-diagnosed type 2 diabetes treated with short-term continuous subcutaneous insulin infusion

目的:观察初诊2型糖尿病(T2DM)患者短期胰岛素泵强化治疗后血清γ谷氨酰转移酶(GGT)的变化,并探讨其变化与胰岛素抵抗的相关性。方法:32例初诊T2DM患者接受胰岛素泵强化治疗2周,分别于治疗前、后行口服葡萄糖耐量试验(OGTT)及胰岛素释放试验,并检测血脂、血清GGT等相关代谢指标。结果:①初诊T2DM患者经胰岛素泵强化治疗2周后空腹血糖由(11.60±2.89)mmol/L下降至(6.82±1.01)mmol/L,餐后2h血糖由(22.52±4.57)mmol/L下降至(13.81±3.10)mmol/L,稳态模型评估的胰岛素抵抗指数(HOMA-IR)由2.20(1.45～3.07)降低至1.37(0.89～1.90),胰岛素β细胞功能指数(HOMA-β)由12.08(6.47～16.30)上升至29.37(17.82～44.27),差异均有统计学意义(P<0.01)。②血清GGT水平由24.00(18.00～35.00)U/L下降至18.00(16.00～27.00)U/L,差异有统计学意义(P=0.005)。③Pearson相关分析显示,T2DM患者血清GGT水平与HOMA-IR呈正相关(r=0.418,P<0.05)。同时,胰岛素泵治疗后血清GGT降低的水平(ΔGGT)与胰岛素抵抗指数的降低程度(△HOMA-IR)呈正相关(r=0.433,P<0.05)。④多元逐步回归分析显示,△HOMA-IR是影响ΔGGT的独立相关因素。结论:初诊T2DM患者经短期胰岛素泵强化治疗后血清GGT水平降低,血清GGT在胰岛素抵抗的发生、发展中可能具有重要作用。

Objective： To investigate the effects of short-term continuous subcutaneous insulin infusion （CSII） on serum gamma-glutamyhransferase （GGT） levels in patients with newly-diagnosed type 2 diabetes mellitus, and to study the association between insulin resistance and GGT. Methods： Thirty-two patients with newly-diagnosed type 2 diabetes mellitus were treated with CSII for 2 weeks. Oral glucose tolerance test and insulin releasing test were performed before and after intensive insulin therapy, meanwhile, blood lipid, serum GGT and other items were measured. Results ： ① Two weeks of CSII treatment in type 2 diabetic pa- tients resulted in significant reduction in fasting serum insulin[ （11.60 ± 2.89） vs （6.82 ± 1.01 ）mmol/L, P 〈 0.01 ], postprandial serum insulin [ （22.52 ± 4.57 ） vs （ 13.81 ± 3.10） mmol/L, P 〈 0.01 ] and homeo- stasis model assessment for insulin resistance（HOMA-IR） [ 2.20 （ 1.45 - 3.07 ） vs 1.37 （0.89 - 1.90 ）, P 〈0.01 ]. ② After CSII treatment for 2 weeks, the level of serum GGT was decreased significantly [ 24.00 （ 18.00 - 35.00） vs 18.00 （ 16.00 - 27.00） U/L, P = 0. 0051. ③ Serum GGT level was positive- ly correlated with HOMA-IR（r = 0. 418,P 〈 0.05 ）. Meanwhile, changes in serum GGT levels were posi-tively correlated with changes in HOMA-IR （ r = 0. 433, P 〈 0.05 ）. @ The multiple regression analysis showed that the HOMA-IR were independent related factors in the influence of the serum GGT levels. Con- elusion： In type 2 diabetic patients, elevated serum GGT levels were significantly decreased after CSII treatment. It might indicate that serum GGT plays an important role in the development of insulin resist- ance.