2型糖尿病患者活体胰腺体积的评价与临床相关性研究

Evaluation of pancreatic volume changes in type II diabetes mellitus and clinical correlational research

目的探讨T2MD人群胰腺体积的变化，评价胰体比作为评估T2MD病进程指标的可行性。方法对78例T2MD患者及35例正常对照组进行上腹部CT螺旋扫描，应用GEadvantage station4．2工作站测量胰腺体积，同体表面积比值得出胰体比，并按病程、年龄、治疗方式的不同进行分组及差异性分析，测量其中38例（男24例，女14例）糖尿病患者HOMA2值，与胰体比进行相关性分析。结果成人胰体比与年龄呈负相关，小于40岁达到峰值，40～60岁变化较小，60岁以后逐步出现退变，糖尿病人群胰腺萎缩程度明显、变异大；T2MD人群口服胰岛素治疗组较药物控制组、饮食控制组发生胰腺体积萎缩的程度明显；相关性分析提示糖尿病病程为加重胰腺萎缩的主要因素，胰体比同HOMA2-β呈中度正线性相关（r=0．473），而与HOMA2-IR呈轻度负相关（r=-0．254）。结论：正常男性胰体比为（36．77±5．11）cm3／m2，女性（34．58±4．37）cm3／m2，T2MD患者随病程进展胰腺萎缩明显，胰体比减小，胰体比与胰腺β功能正相关，进一步结合胰腺形态学变化可用于评价糖尿病进程。

Objective To investigate the changes of pancreatic volume in diabetic patients, evaluate the feasibility by using the pancreatic body ratio as the indicator of diabetic procedure. Methods 78 type 2 diabetes mellitus （T2DM） patients served as experimental group while 35 healthy volunteers served as control group. All subjects received upper abdominal CT scan, measured the pancreatic volume and superficial area and calculated the Volume/Superficial Area ratio （pancreatic body ratio） in GE advantage station 4.2 workstation. Based on the course of diseases, ages, and treatment methods, T2DM patients were divided into different groups. The HOMA2 value was measured in 38 patients （male 24 cases, female 14 cases）, the correlation between HOMA2 value and pancreatic body ratio was analysed. Results In adult patients, the pancreatic body ratio was negatively correlated with ages, peaked in 〈 40, small changes in 40 to 60 ,and gradually declined 〉 60. The atrophy of pancreas can be observed significantly in diabetic patients. The atrophy of pancreatic volume was more significantly in oral insulin treatment group compared with the drug control group and diet control group; The correlation analysis showed that the course of diabetes was the main factor that aggravated the atrophy of pancreas. Pancreatic body ratio was moderate positively linear correlated with HOMA2 -β （r = 0.473）, and mild negatively correlated with HOMA2 - IR（r = - 0.254）. Conclusions The pancreatic body ratio was （36.77 ± 5.11） cm3/m2 in normal male, and in the women the ratio was （34.58 ± 4.37） cm3/m2. The pancreatic volume shrinked and the pancreatic body ratio decreased obviously with the course of disease in diabetics patients. The pancreatic body ratio was positively correlated with pancreatic βfunction, which could be used to evaluate the diabetic procedure combined with the pancreatic morphology changes.