2型糖尿病患者胰岛功能与血糖波动的相关性研究

Correlation between islet function and glycemic variability in type 2 diabetic patients

目的 探讨2型糖尿病(T2DM)患者胰岛功能状态与血糖波动的关系。方法 选取62例T2DM患者为研究对象,通过7个点指血血糖计算平均血糖波动幅度(MAGE)、最大血糖波动幅度(LAGE)、血糖水平标准差(SDBG)、餐后血糖漂移幅度(PPGE)、空腹血糖变异系数(FPG-CV)和日间血糖平均绝对差(MODD)等血糖波动指标。通过口服葡萄糖耐量试验、胰岛素兴奋试验+C肽兴奋试验,采用稳态模型法的胰岛素分泌指数(HOMA-β)、胰岛素抵抗指数(HOMA-IR)以及C肽曲线下面积(AUCC肽)评价胰岛功能。分析胰岛功能与血糖波动的相关性。结果 HOMA-IR与血糖波动指标(MAGE、LAGE、SDBG)呈负相关性(rs<0,P<0.05);HOMA-β与血糖波动指标(MAGE、SDBG)呈显著负相关性(rs<0,P<0.01),与LAGE、FPG-CV呈负相关性(rs<0,P<0.05);AUCC肽与除MODD之外的其他血糖波动指标均呈负相关性;血糖波动异常的患者胰岛β细胞分泌功能较差(P<0.01),C肽释放曲线下面积较小(P<0.05),异常MAGE组与正常MAGE组HOMA-IR无差异(P>0.05)。结论 胰岛细胞功能与血糖波动水平呈负相关。

Objective To investigate the relationship between islet function status and glycemic variability in patients with type 2 diabetes mellitus(T2 DM).Methods 62 T2 DM patients in the outpatient department and ward of Endocrinology of First Teaching Hospital of Tianjin University of TCM were taking as the research objects,glycemic variability indicators include mean amplitude of glycemic excursion(MAGE),large amplitude of glucose excursions(LAGE),standard deviation of blood glucose(SDBG),postprandial glucose excursion(PPGE);daytime glycemic variability index:fasting plasma glucose variability(FPG-CV)and absolute mean of daily difference(MODD)were calculated by 7 points of blood glucose.The insulin secretion index(HOMA-β),insulin resistance index(HOMA-IR)and area under C-peptide curve(AUCC-peptide)were used to evaluate the function of islets by oral glucose tolerance test,insulin excitation test and C-peptide excitation test.The correlation between islet function and glycemic variability was analyzed.Results HOMA-IR was negatively correlated with intraday glycemic variability index(MAGE,LAGE,SDBG)(P<0.05).HOMA-βwas significantly negatively correlated with glycemic variability index(MAGE,SDBG)(rs<0,P<0.01),and negatively correlated with LAGE and FPG-CV(rs<0,P<0.05).AUCC-peptide was negatively correlated with other glycemic variability indexs except MODD.The isletβ-cell secretion function was poor in patients with abnormal glycemic variability(P<0.01),and the area under C-peptide release curve was small(P<0.05).There was no difference between HOMA-IR in abnormal MAGE group and normal MAGE group(P>0.05).Conclusion Islet cell function is negatively correlated with glycemic variability.