不同体质指数2型糖尿病患者胰高血糖素水平的变化研究

Comparison of Glucagon Level Among Type 2 Diabetic Patients With Different Body Mass Index

目的比较不同体质指数(BMI)2型糖尿病患者胰高血糖素、胰岛素水平的变化。方法选择2013年5月—2014年5月于天津医科大学代谢病医院住院的2型糖尿病患者328例为研究对象,按BMI分为正常体质量组、超重组、肥胖组,行口服葡萄糖耐量试验及胰岛素、胰高血糖素释放试验,比较不同BMI组间胰高血糖素曲线下面积、胰高血糖素/胰岛素比值的变化。结果正常体质量组、超重组、肥胖组胰岛素抵抗指数(HOMA-IR)、胰岛β细胞功能指数(HOMA-β)、早期胰岛素分泌指数(ΔI30/ΔG30)依次升高,胰岛素敏感性指数(ISI)依次降低,组间两两比较差异均有统计学意义(P<0.05)。肥胖组空腹及糖负荷后30 min胰高血糖素水平高于正常体质量组、超重组,差异有统计学意义(P<0.05);正常体质量组、超重组、肥胖组空腹胰高血糖素/胰岛素逐渐降低,差异有统计学意义(P<0.05);超重组、肥胖组糖负荷后各时间点胰高血糖素/胰岛素低于正常体质量组,差异有统计学意义(P<0.05)。肥胖组胰高血糖素曲线下面积大于正常体质量组、超重组,差异有统计学意义(P<0.05)。Pearson相关分析显示,空腹胰高血糖素与BMI、空腹血糖(FPG)、75 g葡萄糖负荷后2 h血糖(2 h PG)、HOMA-IR呈正相关(r=0.189、0.235、0.176、0.162,P<0.01),与ISI呈负相关(r=-0.162,P<0.01)。多元线性回归分析显示,BMI(β=0.182,t=3.252,P<0.01)、FPG(β=0.150,t=2.158,P<0.05)是空腹胰高血糖素的影响因素。结论 2型糖尿病患者随BMI增加,胰高血糖素水平升高,胰岛α细胞功能紊乱,胰岛素抵抗加重。

Objective To compare glucagon level and insulin level among type 2 diabetic patients with different body mass index （ BmI ）. Methods We enrolled 328 patients with type 2 diabetes mellitus who were admitted into metabolic Diseases Hospital of Tianjin medical University from may 2013 to may 2014. According to BmI,the patients were divided into three groups：normal BmI group,overweight group,obesity group. The oral glucose tolerance test（ OGTT）and the glucagon release test were undertaken,and comparison was made in area under the curve（ AUC）of glucagon and glucagon/insulin ratio among the three groups. Results The normal BmI group was lowest in HOmA-IR,HOmA-βandΔI30/ΔG30 and highest in ISI,followed by the overweight group and the obesity group with the differences significant（P〈0. 05）. The obesity group was higher than normal BmI group and overweight group in 30 min after glucagon load （ P 〈0. 05 ）. The normal BmI group was highest in fasting glucagon/insulin ratio,followed by the overweight group and obesity group with the differences significant（ P〈0. 05）,and the overweight group and the obesity group were lower（P〈0. 05）than the normal BmI group in glucagon/insulin ratio at each time point after glucose load. The obesity group was higher（P〈0. 05）than the normal BmI group and overweight group in AUC of glucagon. The Pearson correlation analysis showed that fasting glucagon was positively correlated with BmI, FPG,2 hPG and HOmA - IR（r =0. 189,0. 235,0. 176,0. 162,P 〈0. 01）and negatively correlated with ISI（r =-0. 162,P〈0. 01）. multiple regression analysis showed that,BmI（β =0. 182,t =3. 252,P 〈0. 01）and FPG（β =0. 150,t=2. 158,P〈0. 05）were the influencing factors for fasting glucagon. Conclusion Higher BmI of type 2 diabetic patients is associated with higher glucagon level,dysfunction of insulin α-cell and severer insulin resistance.