血糖控制水平对糖尿病合并动脉粥样硬化患者血清铁蛋白、胰岛α细胞及胰岛β细胞功能的影响

Effect of blood glucose control level on serum ferritin,islet alpha and beta cell function in patients with diabetes mellitus and atherosclerosis

目的探讨血糖控制水平对T2DM合并动脉粥样硬化(AS)患者血清铁蛋白(SF)、胰岛α、β细胞功能的影响。方法纳入233例T2DM合并AS患者,按HbA_1c水平分为6.0%≤HbA_1c<7.0%组、7.0%≤HbA_1c%8.0%组及HbA_1c≥8.0%组。检测各组SF和OGTT后0、30、60、120、180min PG、C-P、胰升血糖素(Glu)。结果 HbA_1c≥8.0%组各时间点C-P、PG均高于其他两组(P<0.05或P<0.01),Glu 0、30、60、120及180 min均高于其他两组(P<0.05或P%0.01);7.0%≤HbA_1c<8.0%组C-P、Glu 60、120及180 min均高于6.0%≤HbA1c<7.0%组(P<0.05或P<0.01),PG 30、60、120及180 min均高于6.0%≤HbA_1c<7.0%组(P<0.05);HbA_1C≥8.0%组AUC_(C-P)、AUC_(Glu)、AUC_(PG)高于其他两组(P<0.05),7.0%≤HbA_1c<8.0%组AUC_(C-P)、AUC_(Glu)高于6.0%≤HbA_1 c<7.0%组(P<0.05)。多元逐步回归分析显示,AUC_(C-P)BMI、SF、TS、AUC_(PG)、总铁结合力(TIBC)是AUC_(C-P)的影响因素;BMI、2 hPG、SF、SI、TS、AUC_(PG)、TIBC是AUC_(Glu)的影响因素。结论 T2DM合并AS患者SF过负荷不仅损伤胰岛β细胞,同时也影响胰岛α细胞分泌功能。

Objective To investigate the effect of blood glucose control level on serum {erritin （SF） ,pancreatic islet alpha and beta cell function in patients with type 2 diabetes mellitus （T2DM） and atheroselerosis （AS）. Methods 233 patients with T2DM and AS were divided into 6.0%≤HbA1 c〈 7. 0% group,7.0%≤HbA1c〈8.0% group and HbA1 c≥8.0% group according to HbA1 c level. Serum ferritin （SF） and glucose,C-peptide （C-P） and pancreatic glueagon （Glu） after OGTT test 0,30,60,120, and 180 rain were detected. Results The levels of C-P and PG in HbA1c≥ 8.0% group were significantly higher than those in 6.0%≤HbA1 c〈7.0% group and 7.0%≤HbA1 c〈8.0% group at each point （P〈0. 05 or P〈0. 01）. The levels of Glu in HbA1 c≥8. 0% group were significantly higher than 6.0%≤HbAlc〈7.0% group and 7.0%≤HbA1c〈8. 0% group at 0,60,120 and 180 rain （P〈0.05 or P 〈0.01）. The levels of C-P and Glu in 7.0%≤HbA1 c〈8.0% group at 60,120 and 180 rain were significantly higher than 6.0% ≤ HbA1 c〈 7.0% group （P〈 0. 05 or P〈 0. 01）, PG were significantly higher than 6.0%≤HbAlc〈7.0% group at 30,60 and 180 rain （P〈0.05）. AUCc-p ,AUCGlu and AUCm in HbA1c≥8.0% group [（3.24 ± 1.51）, （6.01 ± 0.33）, （3.91 ± 0. 20）] were significantly higher than 6.0%≤HbA1 c〈 7.0 group[（10.32 ±5.37）, （6.21±0.31） and （4.19± 0. 18）] and 7.0%≤HbA1c〈8. 0% group [（18. 27±10. 64）, （6.38±0. 31） and （4. 26±0. 21） （P〈0. 05）1. AUCc-p and AUCGlu in 7. 0≤HbA1c〈8. 0% group were significantly higher than 6. 0%≤HbA1c〈7.0% group （P〈0. 05）. Multiple regression analysis showed that AUCC-P was positively correlated with BMI, SF, TS and AUCPG and was negatively correlated with TIBC. AUCGlu was positively correlated with BMI, 2 hPG, SF, SI, TS and AUCm and negatively correlated with TIBC. Conclusion The overload of SF may damage pancreatic islet alpha and beta cell function in patients with T2DM and AS.