| 王若梅,陈婧,雷远,等.2型糖尿病胰岛素强化治疗后胰岛β细胞功能变化及影响因素分析[J].安徽医药,2020,24(9):1806-1810. |
| 2型糖尿病胰岛素强化治疗后胰岛β细胞功能变化及影响因素分析 |
| Analysis of the change in islet β-cell function and influencing factors after intensive insulin treatment in type 2 diabetes |
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| DOI：10.3969/j.issn.1009-6469.2020.09.028 |
| 中文关键词: 糖尿病， 2型/治疗 葡糖耐量试验 C肽 血红蛋白 A，糖基化 强化治疗 胰岛 β细胞功能 |
| 英文关键词: Diabetes mellitus,type2/therapy Glucose tolerance test C-peptide Hemoglobin A,glycosylated Intensive insulin therapy β-cell function |
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| 摘要点击次数: 1827 |
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| 中文摘要: |
| 目的了解 2型糖尿病( T2DM)病人经胰岛素多次皮下注射( multiple daily injections，MDI)强化治疗后胰岛 β细胞的功能变化并分析可能的影响因素。方法选取 2018年 9月至 2019年 11月在安徽医科大学第四附属医院内分泌与代谢病科住院治疗的 T2DM病人，收集相关基线资料并行馒头餐试验，所有病人给予 5~7 d MDI强化治疗，待血糖达标后再次行馒头餐试验，计算治疗期间 0hC肽下降幅度( Δ0 h CP％)、馒头餐试验 C肽增加值( CPi)及其下降幅度差值( ΔCPi％)、 C肽曲线下面积(AUCCP)及其上升幅度( ΔAUCCP％)、 2.0 h C肽/0 h C肽及 Δ2.0 h C肽/Δ2.0 h血糖等指标以评估病人胰岛 β细胞功能，采用 Spearman法分析两组变量间的相关性。结果(1)MDI强化治疗后，馒头餐试验各点血糖及血糖曲线下面积降低， CPi、2.0 h C肽/0 h C肽及 Δ2.0 h C肽/Δ2.0 h血糖升高，其中治疗前比治疗后 0h血糖、 2.0 h血糖、 CPi、2.0 h C肽/0 h C肽、 Δ2.0 h C肽/Δ 2.0 h血糖分别为［(9.35±3.47)mmol/L比( 5.87±1.67)mmol/L，t＝8.435，P＝0.000］，［(17.33±4.18)mmol/L比( 12.98±3.09)mmol/L， t＝7.808，P＝0.000］［(1.38±1.27)ng/mL比( 1.91±1.17)ng/mL，t＝-2.896，P＝0.004］［(2.61±2.89)比( 4.02±3.37)t＝-2.959，P＝0.004］［(16.44±20.3，9)比( 27.82±22.35)，t＝-3.507，P＝0.001］；(2)0hC肽水平与体，质量指数( BMI)水平正相关(，r＝0.375， P＝0.000)，与糖化血红蛋白( HbA1c)水平、 Δ0 h CP％水平及病程负相关，其相关系数依次为( r＝-0.344，P＝0.001)、(r＝0.508，P＝000)、(r＝-0.257，P＝0.016)；(3)有症状 T2DM病人血糖高于无症状 T2DM病人， C肽水平反之，其中无症状比有症状 T2DM病人治疗前 3.0 h血糖曲线下面积、治疗后 3.0 h血糖曲线下面积、治疗前 3.0 h AUCCP、治疗后 3.0 h AUCCP分别为［( 40.16±8.06)比( 51.35±11.12)，t＝-5.437，P＝0.000］，［( 30.56±5.66)比( 35.18±9.36)，t＝-2.848，P＝0.006］［( 6.48±4.16)比.0，(4.15±2.27)t＝3.110，P＝0.003］［(7.05±3.98)比( 4.49±2.79)t＝3.380，P＝0.001］；(4)Δ0 h CP％、 ΔCPi％与 MDI治疗前 0h血糖水相关，其相关系次为( r＝0.507，P＝0.000r＝0.387，P＝0.000)；与病程负相关，其相关系数依次为( r＝水平，平正，数依，)、(， |
| 英文摘要: |
| Objective To explore the change of islet β cell function during multiple daily injections(MDI)of insulin in type 2 dia- betic mellitus(T2DM)and analyze the possible influencing factors.Methods Collected the relevant baseline data of the selected type 2 diabetic patients who hospitalized in the Department of Endocrinology and Metabolism Disease of The Fourth Affiliated Hos-pital of Anhui Medical University from September 2018 to November 2019.The steamed bread meal test was performed.All patientswere given 5-7 days MDI treatment.Conducted the test again after the blood glucose reached the standard level.Calculated the de-clined range of the 0 h C-peptide(Δ0 h CP％)，the C-peptide increase value(CPi)of the steamed bread meal test and the differ- ence in the decrease(ΔCPi％)，the area under the C-peptide curve(AUCCP)and its ascensional range(ΔAUCCP％)，2.0 h CP/0 h CP and Δ2.0 h CP/Δ2.0 h BG etc to assess the patients’islet β-cell function.Spearman method was used to analyze the correlation between the two groups of variables.Results(1)The blood glucose(BG)and the area under the glucose curve of each steamed bread meal test time point decreased after the MDI treatment，while CPi、2.0 h CP/0 h CP and Δ2.0 h CP/Δ2.0 h BG increased.The indexes before and after treatment were respectively［(9.35±3.47)mmol/L vs.(5.87±1.67)mmol/L，t＝8.435，P＝0.000］，［(17.33± 4.18)mmol/L vs.(12.98±3.09)mmol/L，t＝7.808，P＝0.000］，［( 1.38±1.27)ng/mL vs.(1.91±1.17)ng/mL，t＝-2.896，P＝0.004］，［(2.61±2.89)vs.(4.02±3.37)，t＝-2.959，P＝0.004］，［(16.44±20.39)vs.(27.82±22.35)，t＝-3.507，P＝0.001］；(2)0 h CP posi- tively related to the body mass index(BMI)(r＝0.375，P＝0.000)， negatively related to glycosylated hemoglobin(HbA1c)，Δ0 h CP％ and course of disease respectively［(r＝-0.344，P＝0.001)，(r＝-0.508，P＝0.000)，(r＝-0.257，P＝0.016)］；(3)The blood glucose level of symptomatic T2DM patients was higher than that of asymptomatic T2DM patients，and the c-peptide level was on the contrary.Among them，the 3.0 h areas under the glucose curve(3.0 h AUCBG)before the treatment in asymptomatic and symp- tomatic T2DM patients were(［ 40.16±8.06)vs.(51.35±11.12)，t＝-5.437，P＝0.000］，the 3.0 h AUCBG after the treatment in as- ymptomatic and symptomatic T2DM patients were［(30.56±5.66)vs.(35.18±9.36)，t＝-2.848，P＝0.006］，the 3.0 h AUCCP before the treatment in asymptomatic and symptomatic T2DM patients were［(6.48±4.16)vs.(4.15±2.27)，t＝3.110，P＝0.003］，the 3.0 h AUCCP after the treatment in asymptomatic and symptomatic T2DM patients were［( 7.05±3.98)vs.(4.49±2.79)， t＝3.380，P＝ 0.001］；(4)Δ0 h CP％， ΔCPi％ positively related to the 0 h BG before the MDI treatment［(r＝0.507，P＝0.000)，(r＝0.387，P＝0.000)］，negatively related to the course of disease［( r＝-0.474，P＝0.000)，(r＝-0.456，P＝0.000)］ .Conclusions MDI treat- ment can significantly improve blood glucose levels and islet function in patients with T2DM.The degree of improvement in isletfunction after MDI treatment was related to the blood glucose level and the course of disease before treatment. |
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