老年2型糖尿病患者胰岛素治疗后胰岛素样生长因子Ⅰ的变化

The change of serum insulin-like growth factor-Ⅰlevel in senile patients with type 2 diabetes mellitus after regular insulin therapy

目的 观察新诊断的老年 2型糖尿病患者胰岛素治疗前后血清胰岛素样生长因子Ⅰ(IGF Ⅰ )的变化。方法 选取用口服葡萄糖耐量试验新确诊的 2型老年糖尿病患者 6 0例 ,测定体重指数、血压、2 4小时尿微量白蛋白 (2 4hUAlb)、空腹及餐后 2h的血糖 (FBG ,P2hBG)、胰岛素 (Ins)和C肽值、HbA1c、IGF Ⅰ ,予常规胰岛素 (RI) 8U、6U、6U ,三餐前皮下注射 ,2天后 ,重复上述检查 ,计算胰岛素抵抗指数 (IR) ;以 40例健康老年人为正常对照。结果 对照组、RI治疗前组和治疗后组IGF Ⅰ的值分别为 (349.0± 49.5 ) μg/L、(2 31.8± 6 4.4) μg/L和 (2 94.2± 46 .2 ) μg/L。IGF Ⅰ治疗前显著低于对照组 (P <0 .0 1) ,治疗后IGF Ⅰ升高但仍低于对照组 (P <0 .0 5 ) ;和对照组相比 ,FBG、P2hBG、HbA1c、餐后 2hIns和C肽及IR较高 (P <0 .0 1) ,RI治疗后 2天 ,血糖下降但未达到正常 ,IR、空腹Ins及餐后 2hIns和C肽仍显著升高 (P <0 .0 1)。结论 老年 2型糖尿病患者血清IGF Ⅰ的水平降低可能与胰岛素抵抗导致的高胰岛素血症及高血糖有关 ,RI治疗可恢复IGF Ⅰ的水平 。

Objective To investigate the change of serum insulin like growth factor Ⅰ (IGF Ⅰ) level in newly diagnosed senile patients with type 2 diabetes mellitus (DM) before and after regular insulin (RI) therapy. Methods Body mass index, blood pressure (BP), 24 hour urinary microalbumin (24hUAlb), fasting blood glucose (FBG), 2 hour postprandial blood glucose (P2hBG), serum insulin (Ins) and C peptide (C P), HbA 1c and IGF Ⅰ were measured in 60 senile type 2 DM patients newly diagnosed by oral glucose tolerance test (OGTT) and 40 healthy senile subject (controls); RI 8 U, 6 U, 6 U were injected to type 2 DM patients before three meals respectively. Two days later, above tests were repeated. Insulin resistance index (IR) was calculated. Results The serum IGF Ⅰ levels were (349.0±49.5)μg/L in control group, (231.8±64.4)μg/L and (294.2±46.2)μg/L in patient group before and after RI therapy, The IGF Ⅰ level was significantly lower before RI therapy than that of controls (P<0.01) and was increased after RI therapy, but still lower than that of controls (P<0.05). The levels of FBG, P2hBG, HbA 1c , IR, 2 hour postprandial Ins and C P in patients before RI treatment were markedly higher than those of controls; Two days after RI therapy, the blood glucose level was decreased but still higher than that of controls, the levels of IR, fasting Ins, 2 hourpostprandialInsandC Pwerealso significantly increased (P<0.01). Conclusion In senile patients with type 2 DM, the decrease of the IGF Ⅰ levels is associated with hyperinsulinemia and high blood glucose resulting from insulin resistance, RI therapy can restore the IGF Ⅰ level but result in concomitant hyperinsulinemia.