短期胰岛素泵强化治疗对初诊2型糖尿病患者血清乳酸脱氢酶的影响

Effect of short-term continuous subcutaneous insulin infusion on the level of lactate dehydrogenase in newly diagnosed type 2 diabetic mellitus

目的:观察初诊2型糖尿病(T2DM)患者血清乳酸脱氢酶(LDH)的水平,及经短期胰岛素泵强化(CSII)治疗后血清LDH的变化,并探讨其变化与胰岛素抵抗的相关性。方法:选取正常糖耐量者(NGT)36例,初诊T2DM患者37例,T2DM组于治疗前后均行口服75 g葡萄糖耐量试验(OGTT),检测各点静脉血浆葡萄糖及胰岛素,并检测血脂、血清LDH等相关代谢指标。结果:①T2DM组血清LDH水平(177.92±43.01)U/L明显高于NGT组(160.97±19.43)U/L,差异有统计学意义(t=2.130,P<0.05)。②T2DM组经CSII强化治疗2周后空腹血糖(FPG)及餐后2 h血糖(2hPG)均明显下降,差异均有统计学意义(P<0.01)。同时稳态模型评估的胰岛素抵抗指数(HOMA-IR)显著下降[2.00(1.35～2.61)vs 1.30(0.91～1.80)]。早相胰岛素分泌(△INS30/△G30)及晚相胰岛素分泌(△INS120/△G120)均明显升高[(1.11±0.95)vs(2.25±2.14),(1.22±1.14)vs(3.57±3.06)],差异均有统计学意义(P<0.05),血清LDH水平显著下降,差异有统计学意义(t=2.397,P<0.05)。③Pearson相关分析显示,T2DM组血清LDH水平与HO-MA-IR成正相关(r=0.359,P<0.05)。④多元逐步回归分析显示,HOMA-IR是影响血清LDH的独立相关因素。结论:初诊T2DM患者经短期CSII强化治疗后胰岛素抵抗及β细胞功能明显改善,同时血清LDH水平显著下降,血清LDH水平与胰岛素抵抗呈正相关。

Objective： To observe the level of serum lactate dehydrogenase （LDH）and to observe the effect of short-term continuous subcutaneous insulin infusion（CSII） on LDH in newly diagnosed T2DM, and to investigate the association between insulin resistance and LDH. Methods： Thirty-six cases as NGT group and 37 newly diagnosed T2DM patients were involved in this study. The newly diagnosed T2DM patients were treated with CSII for 2 week. Before and after CSII therapy, 75 g oral glucose tolerance test（OGTF） were performed. The level of plasma glucose and insulin were examined respectively, serum LDH and other items were also measured. Results： ① Serum LDH levels in the T2DM group（ 177.9 ±43.01 ）U/L were higher than the NGT group（ 161.7± 19.41 ） U/L （t = 2. 130,P 〈 0.05）. ② In the T2DM group, there was a significant decrease in fasting plasma glucose （FPG）and 2 h plasma glucose after glucose overload （2hPG） （P 〈0.01 ）, a significant decrease in homeostasis model assessment for insulin resistance （HO- MA-IR） values [ 2.00 （ 1.35 - 2.61 ） vs 1.30 （0.91 ± 1.80） ], △ INS30/A G30 and △ INS120/ ＆ G120 wereincreased markedly [ （ 1.11 ± 0.95 ） vs （2.25 ± 2.14）, （ 1,22 ± 1.14） vs （3.57 ± 3.06） ] （ P 〈 0.01 ）, se- rum LDH concentrations were significantly decreased （ t = 2. 397, P 〈 0.05 ） after CSII treatment for 2 weeks. ③ In the T2DM group, serum LDH levels positively correlated with HOMA-IR （r = 0. 359, P 〈 0.05 ） . ④ The multiple regression analysis showed that HOMA-IR was an independent related factor in the influence of the LDH concentrations. Conclusion： In the T2DM group insulin resistance and islet β-cell function were improved and serum LDH concentrations were significantly decreased after two weeks CSII treatment. The levels of LDH were positively associated with insulin resistance.