2型糖尿病病程与胰岛β细胞功能的演变

Gradual Deterioration of B-cell Function in Course of Type 2 Diabetic Meilitus

目的:研究2型糖尿病进展过程中胰岛β细胞功能和胰岛素敏感性的变化特点。方法:将113例2型糖尿病患者按照糖尿病病程分3组:A组(<5年)、B组(5～9年)和C组(≥10年)。所有患者均做100 g标准馒头餐试验,测定血糖及胰岛素水平。结果:(1)C组与A组比较空腹血糖水平显著升高(P<0.01)。B组和C组负荷后1,2,3 h血糖均高于A组(P<0.05)。C组负荷后3 h血糖较B组有显著升高(P<0.05)。(2)C组负荷后1 h和2h胰岛素分泌水平降低(P<0.05),胰岛β细胞分泌功能(HOMA-β)显著下降(P<0.01),但胰岛素分泌曲线下面积(AUC)仅与A组有显著性差异(P<0.001)。(3)负荷后胰岛素与基础胰岛素比值(INS1～3/INS0)的特点为C组INS1/INS0和INS2/INS0比值减低(P<0.05)。此外,相关性分析发现,INS1/INS0和INS2/INS0比值分别与空腹血糖、β细胞功能显著相关(P<0.05或P<0.01)。结论:2型糖尿病患者胰岛β细胞继续发生变化,C组胰岛β细胞分泌胰岛素的水平和反应性显著下降。

Objective:To investigate the gradual deterioration of B-cell function in course of type 2 diabetic mellitus(T2DM)and its significance. Methods: According to the diabetic courses, 113 patients with T2DM were divided into 3 groups:group A(<5 years),group B(5-9 years)and group C(>10 years) .After 100 g carbohydrates tolerance test was perfomed, the levels of serum blood glucose(BG) and insulin were measured at 0, 1, 2 and 3 h. Results: (1)The serum BG levels at 1,2 and 3 h in group B and C were significantly higher than that in group A(P<0.05) .The serum BG level at 3 h in group C was signifiantly higher than that in group B(P< 0. 05) . (2) The patients in group C had significantly lower serum insulin levels at 1 h and 2 h(P<0. 05) . The remained B-cell f unction (HOM A-B) significantly decreased (P<0.01), but the AUC in group C was significantly lower than that in group A(P<0. 001). (3)The values of INS1/INSO and INS2/INSO ratio significantly decreased in group C(P<0.05) .The INS1/INSO and INS2/INSO were strongly related to fasting BG and 0-cell function(HOMA-B) with multivariste analysis(P<0. 05 or P<0.01) .Conclusion: The B-cell function is progressively deteriorated along with the diabetic course increasing, especially in those patients with more than 10 years course.