简易胰岛素释放试验对评价胰岛B细胞功能的意义

Significance of easy insulin release test to evaluate the feasibility of islet function

目的探索简易胰岛素释放试验(insulin release test,IRT)对评价2型糖尿病患者胰岛B细胞功能的价值。方法对广东医学院附属医院2003~2013年门诊以及住院的1 631例2型糖尿病患者和168例健康人(正常糖耐量组,即NGT组)口服75g无水葡萄糖粉,行简易IRT和相应时点的血糖测定,按测定结果将糖尿病患者再分为空腹胰岛素低值组(A组)、空腹胰岛素正常组(B组)、空腹胰岛素高值组(C组),将A、B、C各组的结果分别与NGT组进行比较。结果 NGT组中,血清胰岛素的峰值出现在餐后1h,峰值为空腹血清胰岛素值的5倍以上,餐后2h时血清胰岛素明显降低。A组各时点的血清胰岛素值均低于NGT组,在餐后2h时出现低峰值,各时点的血清胰岛素值与NGT组相比差异均有统计学意义(P<0.05)。B组空腹和餐后1h与NGT组无差异,峰值出现在餐后2h,餐后2h血清胰岛素值与NGT组相比差异有统计学意义(P<0.05)。C组各时点血清胰岛素值均明显高于NGT组,峰值出现在餐后2h,各时点血清胰岛素值与NGT组相比差异均有统计学意义(P<0.05)。简易IRT各点的胰岛素水平与相应的糖耐量试验(OGTT)的血糖值均呈负相关。结论简易IRT对评价糖尿病患者的胰岛细胞功能具有一定的临床指导意义。

Objective To observe whether easy insulin release test （IRT） is of clinical significance in evaluating islet B cell function of patients with type II diabetes mellitus （DM）. Methods We gave 1 631 DM patients who came to our hospital between 2003 to 2013 and 168 healthy people 75 g anhydrous glucose powder orally, and tested their blood glucose and insulin level before and after taking glucose respectively. They were divided into 4 groups based on the test results： normal glucose tolerance group （NGT）, low fasting insulin group （A）, normal fasting insulin group （B）, and high fasting insulin group（C）. The results of A, B, C groups were compared separately with those of NGT group. Results In NGT group, the insulin level reached the peak at 1 h after meal, and the peak value was 5 times higher than that of fasting. It decreased obviously at 2 h after meal. In group A, serum insulin values at all time points were lower than those in NGT group, and there was a low peak at 2 h after meal. Serum insulin values at all time points differed significantly from those in NGT group （P^0.05）. In group B, fasting and postprandial 1 hour insulin levels had no difference from those in NGT group, and the insulin level peaked at 2 hours after meal. In group C, serum insulin values at all time points were significantly higher than those in NGT group （P〈0.05）. The peak appeared at 2 h after meal. The plasma insulin level tested with easy IRT at each time point was negatively correlated with the corresponding plasma glucose level. Oonclusion Easy IRT for evaluating islet cell function in patients with DM is of some significance in providing clinical reference.