摘要
目的比较不同糖化血红蛋白(Hb A1c)水平2型糖尿病患者的胰岛α、β细胞功能。方法回顾性分析2016年1月至2017年7月在南通市第一人民医院内分泌科住院就诊且资料完整的2型糖尿病患者467例的临床资料。根据Hb A1c水平将患者分为3组:Hb A1c≤7%组(低Hb A1c组)117例、7.0%<Hb A1c<9.0%组(中Hb A1c组)149例、Hb A1c≥9.0%组(高Hb A1c组)201例。统计各组一般临床指标,记录空腹及口服75 g葡萄糖耐量试验(OGTT)后30、60、120、180 min的血糖(GLU)、C肽和胰高血糖素(GLA)。比较各组各时间点C肽、GLU/GLA、C肽曲线下面积(AUCC肽)、GLU/GLA曲线下面积(AUCGLU/GLA)的变化,并对Hb A1c、AUCC肽、AUCGLU/GLA等行相关性分析。结果随着Hb A1c的升高,空腹及OGTT后各时间点的C肽、AUCC肽均明显下降,差异有统计学意义(P<0.05),低Hb A1c组、中Hb A1c组、高Hb A1c组C肽峰值均出现在口服75 g葡萄糖后120 min,分别为6.56(5.02,9.32)ng/m L、4.58(2.96,6.22)ng/m L、2.46(1.45,3.78)ng/m L。随着Hb A1c的逐步升高,除空腹及OGTT后30 min时中Hb A1c组与高Hb A1c组GLU/GLA比较虽逐步上升,但差异无统计学意义(P>0.05),其余各组各时间点的GLU/GLA、AUCGLU/GLA呈逐步上升趋势,差异亦有统计学意义(P<0.05)。各组均于口服75 g葡萄糖后120min达高峰,峰值分别为0.105(0.067,0.144)mmol/ng、0.146(0.102,0.209)mmol/ng、0.181(0.138,0.246)mmol/ng。Pearson相关分析示Hb A1c与AUCC肽呈负相关(r=-0.6093,P<0.05),与AUCGLU/GLA呈正相关(r=0.3679,P<0.05);AUCC肽与AUCGLU/GLA呈负相关(r=-0.3230,P<0.05)。多元逐步回归分析示Hb A1c与AUCC肽呈负相关[β(SE)=-0.0031(0.0002),P<0.05],与AUCGLU/GLA呈正相关[β(SE)=0.0359(0.0057),P<0.05];AUCC肽与AUCGLU/GLA呈负相关[β(SE)=-0.0133(0.0023),P<0.05],且AUCC肽每下降10%,AUCGLU/GLA上升7.8%。结论 2型糖尿病患者Hb A1c与胰岛细胞功能密切相关。
Objective Comparison of islet alpha and beta cell function in patients with type 2 diabetes at different HbA1c levels. Methods A total of 467 patients with type 2 diabetes were stratified into three groups according to the level of HbA1c: Low HbA1c group( L) ≤ 7.0%,Intermediate group( I),7.0%<HbA1 c<9.0%,High HbA1c group( H) ≥ 9.0%. Anthropometric variables such as height,weight,and blood pressure were measured. 75 g oral glucose tolerance tests( OGTTs) were performed to measure fasting and postprandial 30 min,1 h,2 h,as well as 3 h plasma glucose levels. Serum C-peptide and glucagon levels were also measured at each time point. ANOVA tests were performed to make comparison of C-peptide,plasma glucose/glucagon( GLU/GLA),area under the curve of C-peptide( AUCc-peptide),and area under the curve of GLU/GLA( AUCGLU/GLA) among the three groups. The association of HbA1c with AUCc-peptideand AUCGLU/GLAwere analyzed by Pearson correlation and multiple linear regression tests. Results The C-peptide and AUCc-peptidelevels were both decreased at each time point during OGTTs as HbA1c increased( P<0.05). C-peptide levels in three groups were all peaked at 2 h( C-peptide level was6.56 [5.02,9.32]ng/m L,4.58 [2.96,6.22]ng/m L,2.46 [1.45,3.78] ng/m L in L-,I-,and H-HbA1 c group,respectively). There were significant difference in GLU/GLA and AUCGLU/GLAlevels among the three groups( P < 0. 05) at 1 h,2 h and 3 h,as HbA1c increased,GLU/GLA and AUCGLU/GLAincreased. However,there was no difference in GLU/GLA and AUCGLU/GLAat fasting and 30 min between the I-and H-group( P>0.05). The value of GLU/GLA in three groups were all peaked at 2 h( GLU/GLA was 0.105 [0.067,0.144] mmol/ng,0.146 [0.102,0.209] mmol/ng,0.181 [0.138,0.246] mmol/ng in L-,I-,and H-HbA1 c group,respectively).In addition,Pearson correlation revealed that HbA1c was negatively correlated with AUCc-peptide( r =-0.6093,P<0.05) whereas positively correlated with AUCGLU/GLA( r= 0.3679,P<0.05). Certainly,AUCc-peptidewas negativelyassociated with AUCGLU/GLA( r=-0.3230,P<0.05). After adjusting for covariates in multiple linear regression,the association did not change. We observed that AUCc-peptideand AUCGLU/GLAwas negatively and positively associated with HbA1c,respectively( β =-0.0031,P< 0.05 and β = 0.0359,P< 0.05).AUCc-peptidewas negatively associated with AUCGLU/GLA( β =-0.0133,P<0.05). As AUCc-peptidefell by 10%,AUCGLU/GLAwere up 7.8%.Conclusion HbA1c had a close relationship with pancreatic cells function in patients with type 2 diabetes.
作者
王春华
苏建彬
王雪琴
WANG Chun-hua;SU Jian-bin;WANG Xue-qin(Department of Endocrine,the Second Affiliated Hospital of Nantong University/the First People's Hospital of Nantong,Nantong 226001,Jiangsu,China)
出处
《东南国防医药》
2020年第2期156-160,共5页
Military Medical Journal of Southeast China
基金
江苏省卫生计生委医学科研课题(H201553)
南通市卫生和计划生育委员会科研课题(MB2019010)。