2型糖尿病患者一相胰岛素分泌功能特点与糖尿病微血管病变的相关性

Correlation between first-phase insulin secretion and diabetic microvascular complications in patients with type 2 diabetes

目的利用精氨酸刺激试验探讨2型糖尿病(T2DM)患者一相胰岛素分泌功能特点与糖尿病微血管病变的相关性。方法招募于南通大学附属医院住院治疗的T2DM患者67例,其中男42例、女25例,年龄为(56.4±14.2)岁。根据是否存在微血管病变将患者分为微血管病变组(病例组,n=23)和无微血管病变组(对照组,n=44)。收集两组患者的身高、体质量、糖尿病病程、肾功能、血脂、尿微量白蛋白与尿肌酐等资料,计算体质量指数(BMI)、尿微量白蛋白/肌酐比值(UACR)、估计的肾小球滤过率(eGFR)。空腹状态下进行精氨酸刺激试验,检测空腹和注射精氨酸后2、4、6 min血浆葡萄糖水平和血清胰岛素、C肽水平。计算并比较两组患者的一相胰岛素分泌功能特征,包括急性胰岛素反应(AIR)指数、急性C肽反应(ACR)指数、胰岛素曲线下面积(INSAUC)、稳态模型评估胰岛素抵抗(HOMA-IR)指数等,并分析其与糖尿病微血管病变的相关性。结果病例组患者的糖尿病病程长于对照组,差异有统计学意义(P=0.030)。病例组患者的血清肌酐水平,UACR,空腹和注射精氨酸后2、4、6min胰岛素和C肽水平,AIR指数,INSAUC,HOMA-IR指数均高于对照组,eGFR低于对照组,差异均有统计学意义(P均<0.05)。校正年龄、BMI后的logistic回归分析结果显示,糖尿病病程、AIR指数是T2DM合并微血管病变的危险因素[比值比(OR)=1.099,95%置信区间(CI):1.011～1.194,P=0.026;OR=1.049,95%CI:1.007～1.092,P=0.021]。结论 T2DM微血管病变与糖尿病病程延长、精氨酸刺激后的AIR指数升高相关。

Objective To explore the relationship between the first-phase insulin secretion and diabetic microvascular complications in patients with type 2 diabetes mellitus(T2DM)using arginine stimulating test.Methods Sixty-seven patients with T2DM,aged(56.4±14.2)years,were enrolled from the Affiliated Hospital of Nantong University,and they included 42 males and 25 females.The patients with microvascular complications were assigned to case group(n=23),and the patients without microvascular complications were assigned to control group(n=44).The parameters,including height,body mass,duration of diabetes,renal function,plasma lipids,urinary microalbumin,and urine creatinine,were collected.Body mass index(BMI),urinary microalbumin/creatinine ratio(UACR)and estimated glomerular filtration rate(eGFR)were calculated.The arginine stimulating test was performed in the fasting state.The levels of plasma glucose,and serum insulin and C-peptide were tested in the fasting state,and at 2,4 and 6 min after injecting arginine.The acute insulin response(AIR)index,acute C-peptide response(ACR)index,area under curve of insulin(INSAUC)and homeostasis model assessment of insulin resistance(HOMA-IR)index were calculated,and their correlations with diabetic microvascular complications were analyzed.Results The duration of diabetes of the T2DM patients in the case group was significantly longer than that in the control group(P=0.030).Compared with the control group,the serum creatinine level,UACR,serum insulin and C-peptide levels(in the fasting state and at 2,4,6 min after injecting arginine),AIR index,INSAUC,and HOMA-IR index were higher,and the eGFR was lower in the case group,and the differences were significant(all P<0.05).The logistic regression analysis after adjusting for age and BMI showed that the duration of diabetes and AIR index were significantly correlated with the diabetic microvascular complications(odds ratio[OR]=1.099,95%confidence interval[CI]1.011-1.194,P=0.026;OR=1.049,95%CI 1.007-1.092,P=0.021).Conclusion The diabetic microvascular complications are associated with the long duration of diabetes and high AIR index in the patients with T2DM.