有或无糖尿病家族史的初诊2型糖尿病患者胰岛素泵强化治疗前后早期胰岛素分泌功能的比较

Role of a family history on first-phase insulin secretion in newly diagnosed type 2 diabetic patients with insulin pump therapy

目的：观察有或无糖尿病家族史的初诊2型糖尿病（T2DM）患者胰岛素泵强化治疗前后胰岛素第一时相分泌功能的变化，探讨遗传背景对早期胰岛素分泌功能的影响。方法选取2008年7月1日至2011年12月1日初诊T2DM患者158例，其中有家族史组（FH＋DM）81例，无家族史组（FH-DM）77例，分别给予胰岛素泵治疗10 d，于治疗前和停泵2 d后用左旋精氨酸（L-ARG）刺激法测胰岛素值。两组间比较采用t检验，多个变量间的分析采用多元逐步回归分析。结果（1）胰岛素分泌峰值：治疗前，FH＋DM、FH-DM组胰岛素峰值倍数分别为5.0±2.5、5.2±2.5。强化治疗后，胰岛素峰值倍数分别增加了14.3％和16.1％。（2）胰岛素净分泌量：治疗前FH＋DM组2 min胰岛素值和胰岛素第一时相净分泌量均明显低于FH-DM组。治疗后，两组胰岛素第一时相净分泌量分别为20.41 mU/L、22.39 mU/L（ P＜0.05）；2组胰岛素第一时相净分泌量均较治疗前降低，分别降低了18.4％和20％。（3）稳态模型胰岛素抵抗指数：FH＋DM组与FH-DM组患者治疗10 d后比治疗前降低（分别为4.26比2.02和5.14比2.15，均P＜0.05）。结论胰岛素泵强化治疗对无家族史的初诊T2DM患者胰岛第一时相分泌功能改善作用更明显。

Objective To observe the different effects between patients with or without family history of diabetes with insulin pump therapy , and explore the genetic background of early insulin secretion function.Methods A total of 158 newly diagnosed type 2 diabetic patients from July 1st 2008 to December 1st 2011 were recruited.According to the presence or absence of family history of diabetes , they were divided into 2 group：one was with a family history group （ FH＋DM group） and another was without a family history group（FH-DM group）.All the patients were treated with continuous subcutaneous insulin infusion （CSII） for 10 days.L-arginine （L-ARG） stimulating test was used to test the insulin values before and after intensive insulin therapy.t test was used between 2 groups.Analysis of multiple variables using multiple regression analysis.Results （ 1 ） The peak of insulin secretion： before intensive insulin therapy , the multiples of the peak of the FH ＋DM group and FH-DM group were 5.0 ±2.5, 5.2 ±2.5, respectively.After the therapy , they were increased by 14.3% and 16.1%.（ 2 ） The first phase of insulin secretion：before the therapy ,the level of 2 min insulin incretion and the first phase of insulin secretion in FH ＋DM group was lower than FH-DM.After the therapy , the level of first phase insulin secretion were 20.41 mU/L and 22.39 mU/L of the two groups.They were lowered by 18.4%and 20%,and FH-DM had a more obvious reduction.（3） HOMA-IR：HOMA-IR in the two groups were both lower than before.They were 4.26 vs 2.02,and 5.14 vs 2.15（P〈0.05）.Conclusion Insulin pump therapy has positive effects on the first phase function of islet β-cell.And the result is more obvious in the group without family history.