CAJ | 학술논문

目的探讨不同糖代谢状况下空腹血糖水平与精氨酸刺激后胰岛素急性分泌的关系.方法入选2004至2005年来我院门诊就诊者及健康志愿者626例,其中糖耐量正常114例,糖耐量受损60例,新诊断2型糖尿病452例.在我院内分泌科门诊接受葡萄糖耐量试验及精氨酸试验.测定空腹血糖、胰岛素原及真胰岛素水平,评估精氨酸刺激后胰岛素急性分泌相(△TI).采用稳态模型计算胰岛素抵抗指数(HOMA-IR).运用协方差分析或非参数检验进行统计学分析.结果空腹血糖为3.8～5.0 mmol/L时,△TI由34.13 mmol/L逐渐升至41.50 mmol/L;空腹血糖为5.0 mmol/L时,△TI达到峰值41.50 mmol/L,之后轻度下降;空腹血糖为6.1～10.0 mmol/L时,△TI持续下降并形成平台,较峰值降低近35%;空腹血糖>10.0 mmol/L时,△TI显著减退;空腹血糖>11.1 mmol/L时,△TI达17.40 mmol/L,较峰值降低近60%.空腹血糖为3.8～6.1 mmol/L时,胰岛素原分泌迅速由0.01 pmol/L增至6.96 pmol/L;空腹血糖为6.1～10.0 mmol/L时,胰岛素原分泌持续缓慢增加,并达到峰值10.84 pmol/L;空腹血糖>10.0 mmol/L时,胰岛素原分泌呈显著下降趋势.空腹血糖由3.8 mmoL/L增至7.8 mmol/L时,HOMA-IR呈上升趋势;空腹血糖>7.8 mmol/L时,HOMA-IR维持较高水平(6.82)并处于平台.结论空腹血糖为6.1～10.0 mmol/L时,精氨酸刺激后胰岛素急性分泌相相对稳定,表明胰岛β细胞尚具有较好的储备功能.空腹血糖>10.0 mmol/L时,精氨酸试验激发后△TI及胰岛素原显著下降,提示胰岛β细胞功能严重衰竭.
목적 탐토불동당대사상황하공복혈당수평여정안산자격후이도소급성분비적관계.방법 입선2004지2005년래아원문진취진자급건강지원자626례,기중당내량정상114례,당내량수손60례,신진단2형당뇨병452례.재아원내분비과문진접수포도당내량시험급정안산시험.측정공복혈당、이도소원급진이도소수평,평고정안산자격후이도소급성분비상(△TI).채용은태모형계산이도소저항지수(HOMA-IR).운용협방차분석혹비삼수검험진행통계학분석.결과 공복혈당위3.8～5.0 mmol/L시,△TI유34.13 mmol/L축점승지41.50 mmol/L;공복혈당위5.0 mmol/L시,△TI체도봉치41.50 mmol/L,지후경도하강;공복혈당위6.1～10.0 mmol/L시,△TI지속하강병형성평태,교봉치강저근35%;공복혈당>10.0 mmol/L시,△TI현저감퇴;공복혈당>11.1 mmol/L시,△TI체17.40 mmol/L,교봉치강저근60%.공복혈당위3.8～6.1 mmol/L시,이도소원분비신속유0.01 pmol/L증지6.96 pmol/L;공복혈당위6.1～10.0 mmol/L시,이도소원분비지속완만증가,병체도봉치10.84 pmol/L;공복혈당>10.0 mmol/L시,이도소원분비정현저하강추세.공복혈당유3.8 mmoL/L증지7.8 mmol/L시,HOMA-IR정상승추세;공복혈당>7.8 mmol/L시,HOMA-IR유지교고수평(6.82)병처우평태.결론 공복혈당위6.1～10.0 mmol/L시,정안산자격후이도소급성분비상상대은정,표명이도β세포상구유교호적저비공능.공복혈당>10.0 mmol/L시,정안산시험격발후△TI급이도소원현저하강,제시이도β세포공능엄중쇠갈.
Objective To explore the relationship between fasting plasma glucose (FPG) and acute insulin secretion stimulated by arginine. Methods A total of 626 adults [normal glucose tolerance (n=114), impaired glucose tolerance (n=60), and newly diagnosed type 2 diabetes mellitus (n=452)]were enrolled in this study from 2004 to 2005. All the participants received oral glucose tolerance test and arginine stimulation test. FPG, proinsulin (PI), and true insulin (TI) were measured. Acute insulin release function (△TI) and HOMA-IR were assessed. Covariance analysis and non-parameter test were used for data analysis. Results △TI increased from 34. 13 to 41.50 mmol/L when FPG was 3. 8 to 5.0 mmol/L and reached the peak of 41.50 mmol/L when FPG was 5.0 mmol/L, then decreased gradually with FPG increasing. When FPG was 6. 1 to 10. 0 mmol/L, △TI reached the platform and decreased by about 35% compared with the peak △TI. When FPG was > 10. 0 mmol/L, △TI descended abruptly. △TI declined by about 60% when FPG was > 11.1 mmol/L PI gradually increased from 0. 01 to 6.96 pmol/L when FPG was 3.8 to 10.0 mmol/L. However, PI decreased when FPG was > 10. 0 mmol/L. Insulin resistance index (HOMA-IR) was elevated with the increase of FPG. When FPG was >7. 8 mmol/L, HOMA-IR remained high (6.82) and reached the platform. Conclusions Acute insulin release stimulated by arginine was relatively stable when FPG was 6. 1 to 10. 0 mmol/L, suggesting detectable reserved β cell function. Both △TI and PI were significantly decreased in the arginine stimulation test when FPG was > 10.0 mmol/L,indicating that the acute insulin release function might be severely damaged.