分析初次诊断2型糖尿病患者胰岛功能特点对选择降糖药物的指导意义

The guiding significance of selecting hypoglycemia drugs in accord to analysis of pancreas islet function characteristics in initial diagnosed type 2 diabetic patients

目的通过分析初次诊断2型糖尿病患者的胰岛功能特点,为冠状动脉粥样硬化性心脏病(冠心病)合并糖尿病患者选择降低主要心血管不良事件(MACE)风险的降糖药物提供指导.方法回顾性分析2013年1月至2018年7月天津市红桥医院收治的769例初次诊断2型糖尿病患者的临床资料.按胰岛素与C肽分泌峰值时间是否同步将患者分为同步组(542例)和非同步组(227例).分析两组患者的胰岛功能特点,比较两组总胆固醇(TC)、三酰甘油(TG)、糖化血红蛋白(HbA1c)水平、口服葡萄糖耐量试验(OGTT)+血清胰岛素释放(INS)+C肽检测指标、胰岛素和C肽达峰值时间、稳态模型胰岛素抵抗指数(HOMA-IR)、稳态胰岛素分泌指数(HOMA-β)、定量胰岛素敏感性检测指数(QUICKI)的差异;采用Logistic二元回归分析选出影响初次诊断2型糖尿病患者胰岛素与C肽分泌峰值时间是否同步相关的危险因素.结果同步组TC明显高于非同步组(mmol/L:4.96±1.20比4.78±1.06),HbA1c明显低于非同步组(0.0775±0.0166比0.0827±0.0186,P<0.05).两组血糖、胰岛素水平均随时间延长逐渐升高,于120min达峰值,然后下降,且同步组的血糖水平明显低于非同步组(mmol/L:15.52±3.39比16.18±3.97),而胰岛素水平则明显高于非同步组((mU/L:92.19±78.34比55.99±49.86,均P<0.05);120min起同步组C肽水平明显高于非同步组(μg/L:2.34±0.52比2.16±0.59),持续到180min(μg/L:9.96±4.71比8.99±4.33).同步组胰岛素峰值时间较非同步组明显延迟(min:125.54±28.02比93.30±40.91),但C肽分泌峰值时间更早(min:125.54±28.07比145.11±32.61),差异均有统计学意义(均P<0.05).同步组和非同步组患者HOMA-IR、QUICKI比较差异均无统计学意义〔HOMA-IR:(4.31±3.35)%比(4.15±3.46)%,QUICKI:0.32±0.04比0.33±0.05,均P>0.05〕,但同步组HOMA-β高于非同步组〔(88.64±67.53)%比(76.59±69.41)%,P<0.05〕,ISI则显著低于非同步组(3.98±0.66比4.14±0.74,P<0.05).Logistic回归分析显示,影响胰岛素与C肽释放同步性的因素是胰岛素峰值时间和C肽峰值时间〔优势比(OR)分别为1.077、0.928,95%可信区间(95%CI)分别为1.066~1.088、0.918~0.938〕.结论同步组胰岛素抵抗程度更高;非同步组的胰岛β细胞分泌功能低于同步组;胰岛素抵抗程度越高,胰岛素与C肽释放曲线越同步.

Objective By analyzing the pancreas islet function characteristics of initial diagnosed type 2 diabetes patients to provide guidance of selecting hypoglycemic drugs to lower the risk occurrence of main cardiovascular adverse event(MACE)in patients with coronary arterial atherosclerotic cardiac disease (coronary disease) combined with diabetes mellitus. Methods The clinical data of 769 initial diagnosed type 2 diabetic patients admitted to Tianjin Hongqiao Hospital from January 2013 to July 2018 were retrospectively analyzed. The patients were divided into a synchronous group (542 patients) and a non-synchronous group (227 patients) according to whether the insulin and C-peptide secretion peak times were synchronized or not. The pancreas islet function characteristics of the two groups were analyzed, the differences in the levels of total cholesterol (TC), triacylglycero(TG), glycosylated hemoglobin (HbA1c),oral glucose tolerance test (OGTT), serum insulin release (INS), C-peptide detection index, peak times of insulin and C-peptide, insulin resistance index of steady state model (HOMA-IR), steady-state insulin secretion index (HOMA-β), and quantitative insulin sensitivity test index (QUICKI) were compared between the two groups;Logistic binary regression analysis was used to screen out the risk factors that could be related to the impact of whether the peak value times of insulin and C peptide being synchronous or not in initial diagnosed type 2 diabetic patients. Results The TC in the synchronous group was significantly higher than that in the non-synchronous group (mmol/L: 4.96±1.20 vs. 4.78±1.06), and the HbA1c was obviously lower than that in non-synchronous group (0.077 5±0.016 6 vs. 0.082 7±0.018 6), the differences being statistically significant (all P<0.05). The blood glucose, insulin levels of the two groups gradually increased with time and peaked at 120 minutes, and then went down, and the blood glucose level of the synchronous group was significantly lower than that of the non-synchronous group (mmol/L:15.52±3.39 vs. 16.18±3.97), while the levels of insulin in the synchronous group were significantly higher than those in the non-synchronous group (mU/L: 92.19±78.34 vs. 55.99±49.86, both P<0.05). After 120 minutes, the level of C-peptide in synchronous group was significantly higher than that in non-synchronous group (μg/L: 2.34±0.52 vs. 2.16±0.59), and lasted to 180 minutes (μg/L: 9.96±4.71 vs. 8.99±4.33). The peak time of insulin in the synchronous group was significantly delayed than that in non-synchronized group (minutes: 125.54±28.02 vs. 93.30±40.91), but the C-peptide secretion peak time was earlier (minutes: 125.54±28.07 vs. 145.11±32.61), the differences being statistically significant (all P<0.05). There were no significant differences in HOMA-IR, QUICKI between the two groups [HOMA-IR:(4.31±3.35)% vs.(4.15±3.46)%, QUICKI: 0.32±0.04 vs. 0.33±0.05, both P>0.05], and the HOMA-β of synchronous group was significantly higher than that in the non-synchronous group [(88.64±67.53)% vs.(76.59±69.41)%, P<0.05], ISI in synchronous group was significantly lower than that in non-synchronous group (3.98±0.66 vs. 4.14±0.74, P<0.05). Logistic regression analysis showed that the factors of affecting the synchronization of insulin and C-peptide release were insulin peak time and C-peptide peak time [insulin peak time: odds ratio (OR)= 1.077, 95% confidence interval (95% CI)=1.066-1.088;peak time of C peptide: OR=0.928, 95%CI=0.918-0.938]. Conclusion The degree of insulin resistance in synchronous group is higher than that in non-synchronous group;and the secretion function of pancreas islet beta cells in non-synchronous group is lower than that in synchronous group;the more stronger insulin resistance is, the more synchronous the release curve of insulin and C-peptide is.