目的分析老年2型糖尿病(T2DM)和糖耐量受损(IGT)患者血清骨钙素、胎球蛋白A水平与胰岛素抵抗(IR)和胰岛β细胞功能的相关性。方法选择2019年1月至2021年3月西安交通大学第二附属医院内分泌科诊治的97例老年T2DM患者(T2DM组)以及59例老年...目的分析老年2型糖尿病(T2DM)和糖耐量受损(IGT)患者血清骨钙素、胎球蛋白A水平与胰岛素抵抗(IR)和胰岛β细胞功能的相关性。方法选择2019年1月至2021年3月西安交通大学第二附属医院内分泌科诊治的97例老年T2DM患者(T2DM组)以及59例老年IGT患者(IGT组)作为研究对象,选择同期63名健康体检者为对照组。分别检测各组糖脂代谢指标[三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FBG)、餐后2 h血糖(2 h BG)、糖化血红蛋白(HbA 1c)]、空腹胰岛素(FINS)、空腹C肽(FCP)、骨钙素、胎球蛋白A水平,并计算稳态模型评估的IR指数(HOMA-IR)、稳态模型评估的胰岛β细胞功能指数(HOMA-β)。结果与对照组相比,T2DM组和IGT组LDL-C、FBG、2 h BG、HbA 1c、FINS、HOMA-IR水平均显著升高(P<0.05),且T2DM组高于IGT组(P<0.05),T2DM组和IGT组FCP、HOMA-β水平均显著降低(P<0.05),且T2DM组低于IGT组(P<0.05);T2DM组TG水平高于对照组(P<0.05),但IGT组与对照组TG水平比较差异无统计学意义(P>0.05)。与对照组相比,IGT与T2DM组患者骨钙素水平均显著降低,胎球蛋白A水平显著升高(P<0.05),且T2DM组骨钙素水平低于IGT组,胎球蛋白A水平高于IGT组(P<0.05)。T2DM患者血清骨钙素水平与HOMA-IR、FINS、HbA 1c呈负相关(均P<0.01),与HOMA-β呈正相关(P<0.01),与FCP无相关性(P>0.05)。T2DM患者血清胎球蛋白A水平与HOMA-IR、FINS、HbA 1c呈正相关(均P<0.01),与HOMA-β、FCP呈负相关(均P<0.01)。结论老年T2DM和IGT患者血清骨钙素、胎球蛋白A水平存在明显差异,两者有望成为评估老年T2DM患者胰岛β细胞功能、IR的可靠指标。展开更多
Background: Lack of first phase insulin secretion during oral glucose tolerance test [OGTT] in Type 2 Diabetes Mellitus (DM) is attributed to glucose toxicity. Alternatively, the role of insulin resistance in impaired...Background: Lack of first phase insulin secretion during oral glucose tolerance test [OGTT] in Type 2 Diabetes Mellitus (DM) is attributed to glucose toxicity. Alternatively, the role of insulin resistance in impaired insulin release secondary to lack of glucose entry into β cells may be responsible, but is not examined. Aim: The role of insulin sensitivity in 1st phase insulin secretion was assessed. Material and Methods: Plasma glucose (G) and insulin (I) concentrations were determined after an overnight fast (F) and upto 60 minutes during OGTT with glucose 75g in 12 normal (N), 14 with impaired glucose tolerance (IGT) and 41 subjects with Type 2 DM. First phase insulin secretion (Δ Insulin) was determined as a percentage rise from baseline 100x (Peak-Basal)/Basal. Insulin sensitivity was determined as FI x FG (mUxmM/L). Results: FG were normal (7.0 mM/L in Type 2 DM. FI x FG and ? insulin were 35 ± 4 and 389 ± 89% in N;77 ± 5 and 254 ± 65% in IGT;and 235 ± 19 and 95 ± 15% in Type 2 DM. Significant negative correlations were noted between ? insulin one hand and FI x FG on the other amongst all subjects [p < 0.0001 for all correlations]. Conclusion: Decline of 1st phase insulin secretion in IGT and Type 2 DM may be attributed to inhibited release of depleted insulin stores in the β Cells induced by impaired glucose entry due to insulin resistance, and is unlikely to be caused by glucose toxicity in IGT in presence of fasting euglycemia.展开更多
文摘目的分析老年2型糖尿病(T2DM)和糖耐量受损(IGT)患者血清骨钙素、胎球蛋白A水平与胰岛素抵抗(IR)和胰岛β细胞功能的相关性。方法选择2019年1月至2021年3月西安交通大学第二附属医院内分泌科诊治的97例老年T2DM患者(T2DM组)以及59例老年IGT患者(IGT组)作为研究对象,选择同期63名健康体检者为对照组。分别检测各组糖脂代谢指标[三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FBG)、餐后2 h血糖(2 h BG)、糖化血红蛋白(HbA 1c)]、空腹胰岛素(FINS)、空腹C肽(FCP)、骨钙素、胎球蛋白A水平,并计算稳态模型评估的IR指数(HOMA-IR)、稳态模型评估的胰岛β细胞功能指数(HOMA-β)。结果与对照组相比,T2DM组和IGT组LDL-C、FBG、2 h BG、HbA 1c、FINS、HOMA-IR水平均显著升高(P<0.05),且T2DM组高于IGT组(P<0.05),T2DM组和IGT组FCP、HOMA-β水平均显著降低(P<0.05),且T2DM组低于IGT组(P<0.05);T2DM组TG水平高于对照组(P<0.05),但IGT组与对照组TG水平比较差异无统计学意义(P>0.05)。与对照组相比,IGT与T2DM组患者骨钙素水平均显著降低,胎球蛋白A水平显著升高(P<0.05),且T2DM组骨钙素水平低于IGT组,胎球蛋白A水平高于IGT组(P<0.05)。T2DM患者血清骨钙素水平与HOMA-IR、FINS、HbA 1c呈负相关(均P<0.01),与HOMA-β呈正相关(P<0.01),与FCP无相关性(P>0.05)。T2DM患者血清胎球蛋白A水平与HOMA-IR、FINS、HbA 1c呈正相关(均P<0.01),与HOMA-β、FCP呈负相关(均P<0.01)。结论老年T2DM和IGT患者血清骨钙素、胎球蛋白A水平存在明显差异,两者有望成为评估老年T2DM患者胰岛β细胞功能、IR的可靠指标。
文摘Background: Lack of first phase insulin secretion during oral glucose tolerance test [OGTT] in Type 2 Diabetes Mellitus (DM) is attributed to glucose toxicity. Alternatively, the role of insulin resistance in impaired insulin release secondary to lack of glucose entry into β cells may be responsible, but is not examined. Aim: The role of insulin sensitivity in 1st phase insulin secretion was assessed. Material and Methods: Plasma glucose (G) and insulin (I) concentrations were determined after an overnight fast (F) and upto 60 minutes during OGTT with glucose 75g in 12 normal (N), 14 with impaired glucose tolerance (IGT) and 41 subjects with Type 2 DM. First phase insulin secretion (Δ Insulin) was determined as a percentage rise from baseline 100x (Peak-Basal)/Basal. Insulin sensitivity was determined as FI x FG (mUxmM/L). Results: FG were normal (7.0 mM/L in Type 2 DM. FI x FG and ? insulin were 35 ± 4 and 389 ± 89% in N;77 ± 5 and 254 ± 65% in IGT;and 235 ± 19 and 95 ± 15% in Type 2 DM. Significant negative correlations were noted between ? insulin one hand and FI x FG on the other amongst all subjects [p < 0.0001 for all correlations]. Conclusion: Decline of 1st phase insulin secretion in IGT and Type 2 DM may be attributed to inhibited release of depleted insulin stores in the β Cells induced by impaired glucose entry due to insulin resistance, and is unlikely to be caused by glucose toxicity in IGT in presence of fasting euglycemia.
文摘目的:分析报告正常糖耐量(NGT)与糖代谢异常人群的胰岛素抵抗(IR)和胰岛β细胞分泌功能。方法:选用2h胰岛素(2hIns)与2h血糖(2hPG)的比值(2hIns/2hPG)、胰岛素抵抗指数(IR I)、胰岛素敏感指数(ISI)和30m in净增Ins/30m in净增血糖(ΔI30/ΔG30),分析NGT、糖耐量受损(IGT)和未诊断、未治疗糖尿病(DM)病人的IR和β细胞分泌功能。结果:从NGT、IGT到新诊断DM组,IR I水平表现为进行性升高的趋势,分别为2.0±1.5、3.1±1.6、4.1±1.8;而2hIns/2hPG、ΔI30/ΔG30和ISI水平进行性降低。组间两两比较差异有统计学意义(P<0.01)。ΔI30/ΔG30和ISI水平与病程显著相关,病程<3年和≥3年两组(2.9±3.2 vs 2.4±2.3、30.2±1.1 vs 23.4±2.3)间比较差异有统计学意义(P<0.01)。多元逐步回归分析结果显示,各指标都进入回归方程。除年龄、2hCP与ISI无相关性外,性别、2hIns/2hPG、ΔI30/ΔG30均与ISI呈显著相关(F值分别为96.3、58.4和47.5,P<0.01)。主要成分分析结果显示,2hIns/2hPG、ISI、2hCP、ΔI30/ΔG30累计贡献率已超过85%(86.5%)。结论:从NGT、IGT到DM2的发展过程中,随着IR的不断加重,胰岛β细胞分泌功能也逐渐减退,多元逐步回归分析和主要成分分析结果显示,2hIns/2hPG、ISI、2hCP、ΔI30/ΔG30、FCP都是反映糖代谢异常人群IR和胰岛β细胞分泌功能障碍的有用指标。
