初诊2型糖尿病患者胰腺体积变化特点及与疾病预后的相关性研究

Study on the characteristics of pancreatic volume changes in newly diagnosed type 2 diabetes patients and its correlation with disease prognosis

目的 观察初诊2型糖尿病(T2DM)患者胰腺体积变化特点,并探讨其与疾病预后的关系。方法 选取初诊T2DM患者125例作为疾病组,根据BMI将疾病组患者分为正常组(BMI<24 kg/m~2)77例、超重组(28 kg/m~2<BMI≤24 kg/m~2)35例和肥胖组(BMI≥28 kg/m~2)13例;根据糖化血红蛋白(HbA1c)水平将其分为轻度升高组(53例)、中度升高组(40例)和显著升高组(32例);另选取115例健康者作为健康组。根据疾病组患者随访期间有无并发症发生,将其分为发生组(46例)和未发生组(79例)。收集所有患者一般资料、胰腺体积、胰岛β细胞功能[空腹C肽(FCP)、空腹胰岛素(FINS)、胰岛β细胞指数(HOMA-β)]、实验室检查指标[空腹血糖(FPG)、餐后2 h血糖(2h PG)、总胆固醇(TC)、甘油三酯(TG)、血淀粉酶(AMS)水平及尿微量白蛋白/肌酐比值(ACR)]及随访情况并分组进行比较。采用Pearson相关分析评估胰腺体积与胰岛β细胞功能及其他生化指标的相关性;采用logistic回归分析探讨T2DM患者发生慢性并发症的影响因素。结果 疾病组患者胰腺体积小于健康组;超重组患者胰腺体积大于正常组;轻度升高组、中度升高组、显著升高组患者胰腺体积、FCP、FINS水平、HOMA-β均依次降低,FPG、2h PG、TC、TG水平及ACR均依次升高(P<0.05)。Pearson相关分析结果显示,T2DM患者胰腺体积与FCP、FINS、HOMA-β均呈正相关,与FPG、2h PG、TC、TG、ACR均呈负相关(P<0.05)。发生组患者HbA1c、ACR均高于未发生组,FCP、FINS、HOMA-β及胰腺体积均低于未发生组(P<0.05)。Logistic回归分析结果显示,HbA1c、ACR升高是T2DM患者发生慢性并发症的独立危险因素,FCP、FINS水平、HOMA-β降低、胰腺体积减小是T2DM患者发生慢性并发症的独立保护因素(P<0.05)。结论 初诊T2DM患者胰腺体积缩小,与胰岛β细胞功能、肾功能、血糖和血脂水平变化等密切相关,且胰腺体积减小是T2DM患者发生慢性并发症的保护因素。

Objective To observe the changes of pancreatic volume in newly diagnosed type 2 diabetes mellitus(T2DM) patients and to explore its correlation with disease prognosis.Methods A total 125 newly diagnosed T2DM patients were selected as the disease group,which were divided into normal group(BMI<24 kg/m~2,77 cases),overweight group(28 kg/m~2<BMI≤24 kg/m~2,35 cases) and obese group(BMI≥28 kg/m~2,13 cases) according to BMI.According to the level of glycosylated hemoglobin(HbA1c),they were divided into mild elevation group(53 cases),moderate elevation group(40 cases) and significant elevation group(32 cases).115 healthy people were selected as the health group.According to the occurrence of complications during follow-up,patients in disease group were divided into occurrence group(46 cases) and non-occurrence group(79 cases).General data,pancreas volume,the function of islet β cell[fasting C peptide(FCP),frasting insulin(FINS) and empty islet β cell index(HOMA-β)],laboratory test indicators[fasting blood glucose(FPG),blood glucose 2 hours after meal(2h PG),total cholesterol(TC),triacylglycerol(TG),blood amylase(AMS) and urinary microalbumin/creatinine(ACR)] and follow-up data were collected and compared between groups.Pearson correlation analysis was used to analyze the correlation between pancreatic volume,islet β cell function and other biochemical indicators;Logistic regression was used to analyze the influencing factors of chronic complications in T2DM patients.Results Pancreas volume patients in disease group was smaller than that in healthy group;pancreas volume patients in overweight group was larger than that in normal group;pancreas volume and levels of FCP,FINS,HOMA-β in mild elevation group,moderate elevation group and significant elevation group decreased in turn,while levels of FPG,2h PG,TC,TG and ACR increased in turn(P<0.05).Pearson correlation analysis showed that the pancreatic volume in T2DM patients was positively correlated with FCP,FINS and HOMA-β,and negatively correlated with FPG,2h PG,TC,TG and ACR(P<0.05).HbA1c and ACR in occurrence group were higher than those in non-occurrence group,FCP,FINS,HOMA-β and pancreatic volume were lower than those in non-occurrence group(P<0.05).Logistic regression analysis showed that increased HbA1c and ACR were independent risk factors for chronic complications of T2DM patients,and decreased FCP,FINS,HOMA-β and pancreatic volume were independent protective factors for chronic complications of T2DM patients(P<0.05).Conclusion The decrease of pancreatic volume in newly diagnosed T2DM patients is closely related to the changes of islet β cell function,renal function,blood glucose and blood lipid levels,and pancreatic volume is a protective factor for the occurrence of chronic complications in T2DM patients.