不同干预方式对新诊断2型糖尿病患者胰岛功能和血清色素上皮衍生因子影响的观察

Effect of different therapies on islet cell function and serum pigment epithelium-derived factor in newly diagnosed type 2 diabetes mellitus patients

目的探讨不同干预方式对新诊断T2DM患者胰岛功能和血清色素上皮衍生因子(PEDF)的影响。方法将60例新诊断T2DM患者随机分为胰岛素泵(CSII,n=30)组和口服降糖药(OAD,n=30)组,血糖达标后维持治疗1周。观察胰岛功能和血清PEDF水平的变化。结果与治疗前相比,治疗后CSII和OAD组FPG[(9.6±2.1)vs(7.1±1.2)mmol/L、(9.4±1.2)vs(6.9±0.9)mmol/L,P<0.01]和TG[(2.6±1.5)vs(1.8±1.2)mmol/L、(2.6±1.2)vs(1.9±1.1)mmol/L,P<0.05]均下降;稳态模型评估胰岛β细胞功能指数有改善[40(19,56)vs 61(40,81)、42(16,57)vs 63(25,80),P<0.05],但早期相胰岛素分泌指数仅在CSII组改善[2.2(0.8,3.3)vs 5.5(1.8,7.1),P<0.01];血清PEDF水平下降[(5.3±3.3)vs(2.2±1.6)mg/L、(5.4±3.1)vs(3.3±1.6)mg/L,P<0.01],且CSII组下降更明显。结论 CSII和OAD均能降低PEDF水平以及改善胰岛功能,但CSII治疗后PEDF降幅更大,且早期相胰岛素分泌得到改善。

Objective To investigate the effect of different therapies on islet beta cell function and serum pigment epithelium-derived factor （PEDF） in newly diagnosed T2DM patients.Methods 60 patients with newly diagnosed T2DM were randomly divided into continuous subcutaneous insulin infusion （CSⅡ,n=30） and oral hypoglycaemic agent （OAD,n=30） group.Patients continued to maintain therapy for 1 week after achieving glycaemic control target.Serum PEDF level was measured at baseline and after treatment.Results The levels of FPG [（9.6±2.1） vs （7.1±1.2） mmol/L;（9.4±1.2） vs （6.9± 0.9） mmol/L,P＜0.01,respectively] and TG [（2.6± 1.5） vs （1.8 ± 1.2） mmol/L; （2.6 ± 1.2） vs （1.9 ±1.1） mmol/L,P＜ 0.05,respectively] were significantly improved in both CSⅡ and OAD group.HOMA-β was increased after treatment in CSⅡ and OAD group[40（19,56） vs 61（40,81） ;42（16,57） vs 63 （25,80）,P＜0.05,respectively],while early-phase insulin secretion index （△I30/△G30） was improved only in CSⅡ group[2.2（0.8,3.3） vs 5.5（1.8,7.1）,P＜0.01].Serum PEDF levels were inhibited after CSⅡ and OAD therapy[（5.3 ± 3.3） vs （2.2 ± 1.6） mg/L; （5.4 ± 3.1） vs （3.3 ± 1.6） mg/L,P ＜ 0.01,respectively],and decrement of PEDF levels in CSⅡ group was markedly greater than in OAD group.Conclusion In newly diagnosed T2DM patients,both CSⅡ and OAD therapy have similar effect on improving glucose and lipid control.The increment of △I30/△G30 and decrement of PEDF are markedly greater in CSⅡ group than in OAD group.