C肽和胰高血糖素测定对肝源性糖尿病的临床意义

Clinical significance of glucagon and C-peptide in patients with hepatogenic diabetes

目的探讨C肽释放试验及胰高血糖素测定对肝源性糖尿病(HD)的临床意义。方法对102例HD、95例2型糖尿病(T2DM)及110例正常对照者(NC)行葡萄糖耐量试验,测定不同时间点血糖、胰岛素、C肽及胰高血糖素水平。采用稳态模型法的胰岛β细胞功能(Homa-β)、同样方法的胰岛素抵抗指数(Homa-IR)及空腹血糖/空腹胰岛素(FPG/FINS)来评估胰岛素抵抗,用胰岛素敏感指数(ISI)评估胰岛素敏感性。结果 HD组FPG低于T2DM组(P<0.05),胰岛素分泌呈高峰延迟型,60、120 min胰岛素及C肽高于T2DM组(P<0.05)。HD组Homa-β及ISI高于T2DM组,FPG/FINS低于T2DM组(P均<0.05)。T2DM组Homa-IR高于NC组,ISI低于NC组(P均<0.05)。HD组胰高血糖素水平高于NC组及T2DM组(P<0.05),60 min达到高峰,180 min恢复正常。结论 C肽释放试验及胰高血糖素测定对鉴别HD有一定价值,对肝细胞损伤程度的判定及预后有一定的临床意义。

Objective To explore the clinical significance of glucagon and C-peptide in the patients with hepatogenic diabetes （HD）. Methods Oral glucose tolerance test （OGTT） was carried out on patients with HD （ n = 102, Group HD） and type 2 dia- betes （T2DM） （ n = 95, Group T2DM） and on normal controls （ n = 110, Group NC）. Plasma glucose, insulin, C-peptide and glucagon were measured. Homeostatic model assessment-β （HOMA-β） was used to evaluate islet beta cell function. HOMA-IR （insulin resistance） and fasting plasma glucose （FPG）/fasting insulin of serum （FINS） were used to assess insulin resistance. In- sulin sensitivity index （ISI） was measured to assess insulin sensitivity. Results The FPG level of GrouP HD was lower than that oI Group T2DM （ P 〈 0.05 ）. A delayed insulin peak was showed in Group HD whose insulin and C-peptide levels at 60- and 120 rain were higher than that of Group T2DM （P 〈 0.05）. HOMA-β and IS1 were higher and FPG/FINS was lower in Group HD than in Group T2DM （ P 〈 0.05 ）. HOMA-IR was higher and ISI was lower in Group T2DM than in Group NC （ P 〈 0.05 ）. The glucagon level of Group HD was higher than that of both Group T2DM and Group NC （ P 〈 0.05 ） , and it reached its peak at 60 rain and re- turned to original level after 180 min. Conclusion C-peptide release test, as well as the level of glueagon, play a key role ＇in the diagnosis of hepatic diabetes and in the judgement of liver cirrhosis.