2型糖尿病患者糖血红蛋白水平与胰岛素分泌关系研究

Relationship between glycated hemoglobin and insulin secretion in T2DM

目的探讨2型糖尿病(T2DM)患者糖化血红蛋白(Hb A1c)水平与血糖、胰岛素分泌的关系。方法选取2014年5月至2015年11月收治T2DM患者300例。按Hb A1c水平分为5组:A组62例(Hb A1c≤7.0%),B组58例(7.0%<Hb A1c≤8.0%),C组52例(8.0%<Hb A1c≤9.0%),D组65例(9.0%<Hb A1c≤10.0%),E组63例(Hb A1c>10.0%)。对所有患者进行口服葡萄糖耐受试验(OGTT)及胰岛素释放试验,均空腹及餐后2 h各采集两管静脉血,测定指标有Hb A1c、空腹血糖(FPG)、负荷后2 h血糖(2 h PG)、空腹胰岛素(FIns)、负荷后2 h胰岛素(FIns),采用稳态模型评价胰岛素细胞功能指数(HOMA-β)和胰岛素抵抗指数(HOMA-IR)。结果 Hb A1c与DM病程同步增长,甘油三酯B、C、E四组均高于A组(P<0.01);各组空腹血糖、餐后2 h血糖、空腹胰岛素水平随着Hb A1c的增加逐渐升高(P<0.01),而负荷后2 h胰岛素(FIns)水平逐渐下降(P<0.01);T2DM患者Hb A1c水平与FPG(r=0.683,P<0.01)、2 h FPG(r=0.764,P<0.01)呈正相关、与FIns(r=0.643,P<0.05)、2 h FIns(r=0.428,P<0.05)、HOMA-β(r=0.587,P<0.05)呈负相关,HOMA-IR与Hb A1c水平无相关性。结论 T2DM患者随着Hb A1c水平的升高,血糖也升高,胰岛素敏感性下降,胰岛β细胞分泌能力减弱。

Objective To investigate the relationship between blood glucose,insulin secretion function and glycosylated hemoglobin（ HbA1c）. Methods Data of 300（ 155 males and 145 females） diagnosed as T2 DM patients was collected from May 2014 to November2015. All patients were divided into 5 groups based on HbA1c level： group A 62 patients（ HbA1c ≤7. 0 %）,group B 58 cases（ 7. 0 % HbA1c≤8. 0 %）,group C 52 cases（ 8. 0 % HbA1c ≤9. 0 %）,D group 65 cases（ 9. 0 % HbA1c≤10. 0 %）,E 63 cases（ HbA1c 10. 0 %）. All patients performed the line oral glucose tolerance test（ OGTT） and insulin release test to detect the HbA1c,FPG,2 hFPG,FIns,2 h FIns and evaluate the HOMA- IR and HOMA- β with stable model. Results The HbA1c level increases with the disease course（ P〈0. 01）. The FPG,2 hFPG,FIns of each group increase as the HbA1c levels（ P〈0. 01）,while 2 h FIns decrease（ P〈0. 01）. The HbA1c level and FPG（ r = 0. 683,P〈0. 01）,2 hFPG（ r = 0. 764,P〈0. 01） has a positive correlation,and a negative correlation with Fins（ r = 0. 643,P〈0. 05）,2 h FIns（ r = 0. 428,P〈0. 05） 、HOMA- β（ r = 0. 587,P〈0. 05）. Conclusion T2 DM patients with elevated HbA1c levels,elevated blood sugar,insulin sensitivity decreased,islet β cells secrete diminished capacity.