糖尿病眼肌麻痹患者胰岛素抵抗及β细胞功能分析

Analysis of Insulin Resistance and β-Cell Function in Patients with Diabetic Ophthalmoplegia

目的通过口服葡萄糖-胰岛素释放实验(OGIRT),分析2型糖尿病眼肌麻痹患者胰岛β细胞功能、胰岛素敏感性及胰岛素抵抗与神经病变的关系。方法对32例2型糖尿病眼肌麻痹患者(T2DM+OMP)、32例2型单纯糖尿病患者(T2DM)及32例健康对照者(NC)测定隔夜空腹12 h血糖(FBG)、胰岛素(FINS)、糖化血红蛋白(HbA1c);根据口服葡萄糖耐量试验(OGTT)及胰岛素释放试验(IRT),用稳态模型方法计算各组人群空腹胰岛素抵抗指数(HOMAIR)、胰岛素敏感指数(ISI)及胰岛β细胞功能(HOMA-β),评价基础胰岛素分泌功能和胰岛素抵抗;用△I30/△G30、胰岛素曲线下面积(INSAUC)评价胰岛素分泌功能。结果 T2DM+OMP组FBG、HOMA-IR、HbA1c均显著高于T2DM组及NC组(均P<0.01);FINS低于T2DM组高于NC组(P<0.05);ISI、HOMA-β、△I30/△G30、INSAUC显著低于T2DM组及NC组(均P<0.01)。T2DM组FBG、HOMA-IR、HbA1c高于NC组(均P<0.01),ISI、HOMA-β、△I30/△G30低于NC组(均P<0.01)。结论 2型糖尿病患者同时存在胰岛素分泌缺陷和胰岛素抵抗,糖尿病眼肌麻痹胰岛β细胞功能渐进性减退和胰岛素抵抗渐进性增高,促进了糖尿病微血管及神经病变的发生和发展。通过OGIRT对胰岛素分泌模式及分泌量评价有利于深入理解糖尿病发病机制及合理指导临床工作。

Objective To assess the β-cell function, insulin sensitivity, and relationship between insulin resistance and the neuropathy in patients with diabetic ophthalmoplegia by glucose induced insulin secretion tests. Methods Venous blood samples were collected from 32 type 2 diabetes mellitus（T2DM） patients with ocular muscles palsy（ T2DM ＋ OMP） ,32 T2DM patients without complication （ T2DM ） and 32 healthy controls （ NC ）. The glycosylated hemoglobin 1 c （ HbA1 c）, fasting blood glucose （FBG） ,fasting insulin（FINS） were measured after fasting for 12 h. The status of insulin resistance（HOMA-IR） ,the insulin sen- sitivity index（ISI） and basal insulin secretion（HOMA-β） were quantified by homeostatic model assessment（HOMA） method based on the oral glucose tolerance test（OGTY） and glucose induced insulin release tests（IRT）. Early insulin secretion index （ △I30/△G30 ） and insulin area under the curve （INSAUC） were calculated to evaluate the insulin secretion. Results The levels of plasma FBG,HbAlc,HOMA-IR were significantly higher in T2DM ＋ OMP group than T2DM and NC group（P 〈0.01 ）. The levels of plasma FINS below T2DM group were higher than NC group（ P 〈 0.05 ）. The levels of ISI, HOMA-β, △I30/△G30, IN- SAUC were significantly lower in T2DM ＋ OMP group than T2DM and NC group（ P 〈 0.05 ）. The levels of plasma FBG, HbA1 c, HOMA-IR were significantly higher in T2DM group than NC group（ P 〈 0.01 ）. The levels of ISI, HOMA-β, I30/△G30 , INSAUC were significantly lower in T2DM than NC group （ P 〈 0.01 ）. Conclusion The insulin resistance level rises continually and function of β-cell goes down gradually in patients with diabetic ophthalmoplegia can promote the occurrence and development of diabetic mierovascular complication and neuropathy. The glucose induced insulin secretion tests can assess the β-cell function, in-sulin sensitivity, and relationship between insulin resistance and the neuropathy, the result should reasonably guide clinical work.