1型糖尿病患者胰腺体积和胰腺脂肪含量的相关性研究

The correlation of pancreatic volume and pancreatic fat content in type 1 diabetes mellitus

目的:探讨1型糖尿病(Type 1 diabetes mellitus,T1DM)患者胰腺体积(PV)和胰腺脂肪含量(PFC)的相关因素。方法:回顾性研究我院T1DM患者,将92例患者按照患病时间分为A、B、C 3组。A组:<60月,51例;B组:60~<120月,20例;C组:≥120月,21例。分析各组患者PV、胰腺内脂肪体积(PFV)、PFC、腹部脂肪含量(TA)、腹腔脂肪含量(VA)、腹壁脂肪含量(SA)、VA/SA、体质量指数(BMI)、患病时间(月)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、胆固醇(TC)和低密度脂蛋白胆固醇(LDL-C)、血压(收缩压和舒张压)、血糖(OGTT空腹、餐后2 h)、胰岛素(空腹、1 h、2 h、3 h),C肽(空腹、1 h、2 h、3 h)和糖化血红蛋白(Hb A1c)等相关实验室检查数据之间差异和相关性。结果:A^C三组间,年龄、TG、空腹C肽、1h C肽、PFV和PFC的均值差异具有显著性,P<0.05。A组与B组间空腹C肽和PV,A组与C组间年龄、空腹C肽、1 h C肽、TG、PFV、PFC和VA,B组与C组间TG、PFV和PFC两两比较均值差异有显著性,P<0.05。相关性分析方面:PV与年龄、C肽和患病时间不相关。PFV与VA和HDL-C值呈正相关。PFC与VA和患病时间正相关。C肽与年龄负相关、与BMI正相关。结论 :T1DM患者PV和PFC的变化有其自身特点,PV与胰腺外分泌功能不相关,患病5年以上PV减小,5~10年以后体积减小不明显,这与C肽值变化同步;随患病时间延长PFC逐渐增多,患病10年以上增多明显,这与TG变化同步;PFC与VA和HDL-C相关,PFC变化早于VA变化;C肽与年龄和BMI等相关。与2型糖尿病中PFC与胰岛素抵抗相关不同,推测T1DM中PFC增加可能与稳定胰岛细胞功能相关,这点需要进一步证实。

Objective： To investigate the related factors of pancreatic volume（PV） and pancreatic fat content（PFC） in type 1 diabetes mellitus （T1DM） patients. Methods： We retrospectively reviewed 92 patients who were diagnosed as T1DM in our hospital. And the patients were divided into three groups according to the duration of diabetes （Group A〈60 months, 51 pa- tients; Group B 60-〈120 months, 20 patients; Group C≥120 months, 21 patients）. The difference and correlation among PV, pancreatic fat volume（PFV）, PFC, total abdominal adiposity（TA）, visceral adiposity（VA）, superficial adiposity（SA）, VA/SA, body mass index（BMI）, duration of diabetes（months）, triglyceride（TG）, high density lipoprotein（HDL-C）, total cholesterol（TC）, low den- sity lipoprotein（LDL-C）, blood pressure（systolic and diastolic pressure）, blood sugar（OGTT fasting and 2 hours after meal）, in- sulin （fasting, 1, 2, 3 hours after meal）, C-peptide （fasting, 1, 2, 3 hours after meal） and glycosylated hemoglobin A,c（HbA^c） were analyzed. Results： There was significant difference in age, TG, C-peptide （fasting, 1 hour after meal）, PFV and PFC a- mong group A-C （P〈0.05）; C-peptide （fasting） and PV between group A and group B; Age, C-peptide （fasting, 1 hour after meal）, TG, PFV, PFC and VA between group A and group C; TG, PFV and PFC between group B and group C （P〈0.05）. PV was not correlated with age, C-peptide or duration of diabetes. PFV was positively correlated with VA and positively correlat- ed with BMI. PFV was positively correlated with HDL-C. PFC was positively correlated with duration of diabetes. Conclusion： The change of PV and PFC in T1DM had its own characteristics. PV was not correlated with pancreatic external secretion function. PV decreased in patients with a diabetic duration of more than 5 years and the trend was less obvious in patients with duration of 5-10 years, which was in step with C-peptide. PFC increased gradually with duration of diabetes, which was extremely obvious in patients with duration of diabetes more than 10 years and was in step with TG. PFC was positively cor- related with VA and HDL-C. The change of PFC was earlier than VA. C-peptide was correlated with age and BMI. We in- ferred that the increase of PFC may have some correlation with the function of pancreas cell, which is different from type 2 diabetes mellitus whose PFC is correlated with insulin resistance. Further study is needed to verify this conclusion.