新诊断酮症起病的2型糖尿病患者胰岛素抵抗及胰岛功能分析

Insulin resistance and pancreatic β-cell function in newly-diagnosed ketosis-prone type 2 diabetic patients

目的探讨新诊断以酮症起病的2型糖尿病(ketosis-prone type 2 diabetic,KPD)患者的胰岛素抵抗及胰岛β细胞功能的临床特点。方法选取2016年1月至2016年12月同济大学附属第十人民医院收治的81例糖尿病患者,其中以酮症起病的T2DM患者(KPD组)25例,无酮症起病的T2DM患者(T2DM组)56例。测量患者的身高、体质量、腰围、血脂、空腹血糖(FPG)、空腹胰岛素(FINS)、空腹C肽(FCP)及糖化血红蛋白(Hb A1C)水平;所有患者行口服糖耐量试验(OGTT)测定各点的血糖、胰岛素及C肽水平,计算胰岛素敏感指数(IS)、内稳态模型评估胰岛素抵抗指数(HOMA-IR)、葡萄糖曲线下面积(AUCGlu)、胰岛素曲线下面积(AUCINS)、早期相胰岛素分泌指数(△I30/△G30)、葡萄糖处置指数(DI)及稳态模型胰岛素分泌指数(HOMA-β),比较两组患者的胰岛素抵抗及胰岛β细胞功能的差异。结果 KPD组的男性患者比例显著高于T2DM组而年龄显著小于T2DM组(P均<0.05)。KPD组的TG及FFA水平显著高于T2DM组而FCP水平显著低于T2DM组(P均<0.05)。与T2DM组相比,OGTT试验后KPD组的血糖水平在120、180 min显著增加,胰岛素水平在30、60、120 min及C肽水平在30、60、120、180 min均显著降低(P均<0.05)。糖负荷后两组的血糖高峰值均在120 min出现且KPD组显著高于T2DM组,KPD组的胰岛素及C肽释放曲线出现延迟,高峰在180 min,T2DM组的胰岛素及C肽释放曲线延迟且高峰在120 min。KPD组患者的HOMA-IR水平显著高于T2DM组而IS、AUCINS、(△I30/△G30)、DI及HOMA-β值均显著低于T2DM组(P均<0.05)。结论在新诊断T2DM患者中,KPD患者较无酮症倾向T2DM患者存在更严重的胰岛素抵抗及胰岛β细胞功能受损。

Objective To investigate the insulin resistance and pancreatic β-cell function in newly diagnosed ketosis-prone type 2 diabetic（ KPD） patients. Methods Eighty-one patients with type 2 diabetes（ T2DM） admitted in Tenth People＇s Hospital,Tongji University from January 2016 to December2016 were enrolled,including 25 patients with ketosis-onset（ KPD group） and 56 patients without ketosis（ T2DMgroup）. Height,weight,waist circumference,lipid profile,fasting plasma glucose（ FPG）,fasting insulin（ FINS）,fasting C peptide（ FCP） and glycosylated hemoglobin（ Hb A1 C）levels were measured; 75 g oral glucose tolerance test（ OGTT） was performed. Insulin sensitivity index（ IS）,homeostasis model assessment of insulin resistance index（ HOMA-IR）,area under the curve of glucose concentration（ AUCGlu）,area under the curve of insulin concentration（ AUCINS）,early-phase insulin secretion index（ △I30/△G30）,glucose disposition index（ DI） and homeostasis model of insulin secretion index（ HOMA-β） were calculated. The insulin resistance and beta-cell function of islets were analyzed and compared between KPD and T2DMgroups. Results Patients in KPD group had significantly higher male to female ratio and lower age than those in T2DMgroup（ P〈0. 05）. KPD group had significantly higher TG and FFA levels,and lower FCP levels than T2DMgroup（ P〈0. 05）. After OGTT,the glucose levels at 120 and 180 min significantly increased while the insulin levels at 30,60,120 min,and C peptide levels at 30,60,120 and 180 min significantly decreased compared to T2DMgroup（ all P〈0. 05）. After a glucose load,the glucose peak appeared at120 min in both groups,and the peak glucose value in KPD group was significantly higher than that in T2DMgroup. The insulin and C peptide releasing curves in both groups were delayed,with the peak appearing at 180 min in KPD group and at 120 min in T2DMgroup. KPD group had remarkably higher HOMA-IR while lower IS,AUCINS,（ △I30/△G30）,DI,and HOMA-β than T2DMgroup（ all P〈0. 05）. Conclusion Among patients with newly diagnosed T2DM,KPD patients had more severe insulin resistance and impaired pancreatic beta-cell function compared to non-ketotic T2DMpatients.