2型糖尿病患者胆囊切除术后糖脂代谢的临床特点及胰岛功能分析

Characteristics of glucose and lipid metabolism and islet function in type 2 diabetic patients with cholecystectomy

目的探讨胆囊切除的T2DM患者糖脂代谢及胰岛功能的变化特点。方法选取2014年3月至2016年7月于天津医科大学代谢病医院糖尿病肾病科住院的T2DM患者648例,分为胆囊切除组138例及对照(Con)组510例,分析两组一般临床资料、生化指标,行OGTT、C-P及胰岛素释放试验,计算葡萄糖、C-P、胰岛素曲线下面积(AUC),稳态模型评估胰岛素抵抗指数(HOMA-IR)、胰岛β细胞功能指数(HOMA-β),并比较两组差异。结果与Con组比较,胆囊切除组BMI、HbA_1c、eGFR、AST比较,差异无统计学意义;ALT、BUN、Scr、SUA、血脂低于Con组(P<0. 05)。胆囊切除组糖负荷后0、30 min PG及0、120、180 min C-P水平高于Con组(P<0. 05);胆囊切除组血糖曲线下面积(AUC_(PG))[(49. 35±9. 81)vs(45. 72±10. 00)h·mmol/L]、AUC_(C-P)[11. 1(8. 1,15. 2)vs 8. 8(7. 1,11. 0)h·ng/ml]及HOMA-IR[3. 7(2. 9,6. 7)vs 3. 1(1. 9,4. 9)]高于Con组(P<0. 05)。Logistic回归分析显示,BUN、HDL-C及AUC_(C-P)是糖尿病患者胆囊切除的影响因素。结论胆囊切除的T2DM患者HDL-C水平偏低,但空腹及糖负荷后早期血糖偏高,胰岛素分泌高峰后延。因此,改善早期时相胰岛素分泌及HDL-C水平可能有助于胆囊切除患者的血糖控制。

Objective To investigate the alteration of glucose and lipid metabolism and islet function in type 2 diabetic patients with cholecystectomy.Methods Type 2 diabetic inpatients with or without a history of cholecystectomy were enrolled in this study from Nephropathy Department of Metabolic Disease Hospital of Tianjin Medical University from March 2014 to July 2016.All the patients were divided into two groups:patients with cholecystectomy and patients without cholecystectomy(Con group).The general clini-cal data,biochemical markers,results of oral glucose tolerance test(OGTT),results of insulin and C-pep-tide releasing test were recorded.Area under the curve(AUC)of glucose,C-peptide and insulin,homeosta-sis model assessment-insulin resistance index,ulin,homeostasis mod were calculated and compared between the two groups.Results BMI,HbA1c,eGFR and AST were similar in the two groups.ALT,BUN,Scr and SUA were lower in cholecystectomy group than in Con group(P<0.05).The blood glucose levels at 0,30 minutes and the C peptide levels at 0,120,180 minutes after glucose load were higher in cholecystecto-my group than in Con group(P<0.05).The AUCPG[(49.35±9.81)vs(45.72±10.00)h·mmol/L],AUCC-P[11.1(8.1,15.2)vs 8.8(7.1,11.0)h·ng/ml]and HOMA-IR[3.7(2.9,6.7)vs 3.1(1.9,4.9)]were higher in cholecystectomy group than in Con group(P<0.05).Multiple regression analysis showed that BUN,HDL-C and AUCC-Pwere independent relevant factors for cholecystectomy.Conclusion HDL-C was lower,fasting and postprandial plasma glucose levels soon after glucose load were higher,and the peak of insulin secretion is delayed in T2DM patients.Therefore,improving the early phase insulin secretion and HDL-C may be helpful in controlling blood glucose in diabetic patients with cholecystectomy.