对库欣综合征患者不同糖代谢状态下胰岛功能的观察

Islet function in patients with Cushing’s syndrome under different glucose metabolic states

目的研究库欣综合征(CS)患者不同糖代谢状态下的胰岛功能。方法选取2011年1月至2016年3月于我院内分泌科住院的CS患者60例,根据OGTT结果分为CS正常糖耐量组(CNGT,n=14)、CS葡萄糖调节受损组(CIGR,n=20)及类固醇性糖尿病组(SDM,n=26)。同期住院的IGR患者(IGR组,n=20)、T2DM患者(T2DM组,n=26)及体检健康者(NC组,n=23)为对照,行OGTT、静脉葡萄糖耐量试验(IVGTT),评估各组胰岛素第1时相、第2时相分泌功能。结果OGTT中,CIGR组、SDM组胰岛素曲线下面积(AUC)、胰岛素曲线下面积/血糖曲线下面积高于IGR组及T2DM组(P<0.05);SDM组峰值胰岛素高于T2DM组(P<0.05)。IVGTT中,SDM组急性时相胰岛素分泌、胰岛素AUC、峰值胰岛素、峰值胰岛素/基础胰岛素均高于T2DM组(P<0.05)。结论SDM组胰岛功能优于T2DM组,第1时相分泌仍存在;IVGTT中Ip/I0可为SDM与T2DM的鉴别提供依据。

Objective To compare the islet function in patients with Cushing’s syndrome(CS)under different glucose metabolic states.Methods A total of 60 inpatients with CS were selected from Jan 2011 to Mar 2016. According to the OGTT,CS patients was divided into normal glucose tolerance group(CNGT),impaired glucose regulation group(CIGR)and steroid diabetes group(SDM). In the same period,hospitalized IGR patients(n=20),T2DM patients(n=26)and physical examination NC(n=23)were selected as the control group. The phase 1 and phase 2 insulin secretion functions were evaluated by OGTT and intravenous glucose tolerance test(IVGTT).Results OGTT showed that AUCIns 0~3 h,and AUCIns 0~3 h/AUCGlu 0~3 hin CIG group and SDM group were higher than the corresponding control groups(P<0. 05). The value of Ip in SDM group were higher than T2DM group(P<0. 05). IVGTT showed that AIR0~10 min,AUCIns 0~10 min,Ip and Ip/I0 in SDM group were higher than T2DM(P<0. 05).Conclusion The function of insulin secretion in SDM was better than T2DM patients,and its phase 1 secretion is still present. Ip/I0 in IVGTT can provide reference for the clinical identification of SDM and T2DM.