2型糖尿病患者葡萄糖负荷后胰岛素分泌达峰时间的影响因素研究

Influencing Factors of Time to Peak Insulin Level after Glucose Load in Type 2 Diabetic Patients

背景胰岛素分泌高峰延迟在2型糖尿病(T2DM)患者中普遍存在,其可能是T2DM患者餐后高血糖的重要原因。目前国内外对T2DM患者胰岛素分泌高峰延迟影响因素的研究较少。目的探讨T2DM患者葡萄糖负荷后胰岛素分泌达峰时间(t_(max))的影响因素。方法选取2016年1月—2018年6月于武汉科技大学附属孝感医院内分泌科住院的T2DM患者490例,根据t_(max)将患者分为3组:短t_(max)组(t_(max)≤90 min,n=159)、中t_(max)组(90 min<t_(max)≤135 min,n=169)及长t_(max)组(135 min<t_(max)≤_(180min),n=162)。收集患者的一般资料,检测糖化血红蛋白(HbA_(1c))、血酮体、血常规及生化全套,行75 g口服葡萄糖耐量试验(OGTT)和胰岛素释放试验(IRT),测量空腹血糖(FPG,G0 min)、空腹胰岛素(FINS,I_(0min))及试验后30、60、120、_(180min)血糖(G_(30min)、G_(60min)、G_(120min)、G_(180min))及胰岛素(G_(30min)、G_(60min)、G_(120min)、G_(180min))水平。记录葡萄糖负荷后胰岛素分泌峰值(I_(max))及t_(max)。比较3组患者一般资料、实验室检查指标、OGTT和IRT指标,采用Logistic回归分析T2DM患者t_(max)的影响因素。结果 3组患者性别、病程、红细胞计数、血红蛋白含量、G0 min、G_(120min)、G_(180min)、I_(60min)、I_(120min)、I_(180min)比较,差异均有统计学意义(P<0.05);其中,中t_(max)组、长t_(max)组男性与女性之比小于短t_(max)组(P<0.016 7);长t_(max)组红细胞计数、血红蛋白含量低于短t_(max)组,中t_(max)组病程短于短t_(max)组、血红蛋白含量低于短t_(max)组(P<0.05)。长t_(max)组患者G_(120min)、G_(180min)水平高于短t_(max)组,G0 min、G_(120min)、G_(180min)水平高于中t_(max)组(P<0.05);长t_(max)组I_(60min)水平低于短t_(max)组和中t_(max)组,I_(120min)、I_(180min)水平高于短t_(max)组(P<0.05);中t_(max)组I_(120min)、I_(180min)水平高于短t_(max)组(P<0.05)。Logistic回归分析结果显示,G_(120min)水平高是T2DM患者t_(max)延迟的危险因素,G0 min水平高和病程长是T2DM患者t_(max)延迟的保护因素(P<0.05)。结论 G_(120min)水平高是T2DM患者胰岛素分泌高峰延迟的危险因素。

Background Delayed timing of peak insulin level after glucose load is common in patients with type 2 diabetes mellitus(T2DM),which may be an important cause of postprandial hyperglycemia in this population.However,there are no studies concerning the influencing factors of delayed timing of post-load peak insulin level in T2DM patients.Objective To investigate the influencing factors of time to peak insulin level after glucose load in T2DM patients.Methods We selected 490 hospitalized patients with T2DM from Department of Endocrinology,Xiaogan Hospital Affiliated to Wuhan University of Science and Technology from January 2016 to June 2018.We collected their clinical data,serum HbA1c and ketone bodies levels,routine blood test and biochemistry analysis results,FPG,blood glucose levels measured again 30,60,120,180 min utes(G30 min,G60 min,G120 min,G180 min levels) after having glucose solution in a 3-hour 75 g oral glucose tolerance test(OGTT) and fasting insulin(FINS) and INS levels measured again 30,60,120,180 minutes(I30 min,I60 min,I120 min and I180 min levels) after having glucose solution in a 3-hour insulin response test,and recorded peak INS level after glucose load(Imax) and the time during which INS was at its peak(tmax).According to tmax,we divided them into short tmax group(tmax≤ 90 min,n=159),medium tmax group(90 min<tmax≤ 135 min,n=169),and long tmax group(135 min<tmax≤ 180 min,n=162).The general data,laboratory indicators,OGTT and IRN indicators of the three groups were compared.Logistic regression was used to analyze the influencing factors of tmax in patients with T2DM.Results There were significant differences in the distribution of sex,and average course of T2DM,erythrocyte count,HbA1c concentration,G0min,G120 min,G180 min,I60 min,I120 min and I180 min among the three groups(P<0.05).The ratios of male to female in medium and long tmax groups were all less than that in short tmax group(P<0.016 7).The average number of erythrocytes and HbA1c concentration in long tmax group were all less compared with those in short tmax group(P<0.05).The average course of T2DM was shorter and average HbA1c concentration was lower in medium tmax group than those in short tmax group(P<0.05).Long tmax group showed higher average G120 min and G180 min levels than short tmax group,and demonstrated higher average G0min,G120 min and G180 min levels than medium tmax group(P<0.05).Long tmax group presented lower average I60 min level but higher average I120 min and I180 min levels compared with short tmax group,and showed lower average I60 min level compared with medium tmax group(P<0.05).Medium tmax group had higher average I120 min,and I180 min levels than short tmax group(P<0.05).Logistic regression analysis showed that elevated G120 min was a risk factor for tmax in patients with T2DM,and decreased G0min and shorter course of T2DM were protective factors for tmax(P<0.05).Conclusion Elevated G120 min is an independent risk factor for delayed timing of peak insulin level after glucose load in patients with T2DM.