CAJ | 학술논문

目的：比较不同体质指数（BmI）2型糖尿病患者胰高血糖素、胰岛素水平的变化。方法选择2013年5月—2014年5月于天津医科大学代谢病医院住院的2型糖尿病患者328例为研究对象，按BmI分为正常体质量组、超重组、肥胖组，行口服葡萄糖耐量试验及胰岛素、胰高血糖素释放试验，比较不同BmI组间胰高血糖素曲线下面积、胰高血糖素/胰岛素比值的变化。结果正常体质量组、超重组、肥胖组胰岛素抵抗指数（ HOmA-IR）、胰岛β细胞功能指数（HOmA-β）、早期胰岛素分泌指数（ΔI30/ΔG30）依次升高，胰岛素敏感性指数（ISI）依次降低，组间两两比较差异均有统计学意义（ P<0.05）。肥胖组空腹及糖负荷后30 min胰高血糖素水平高于正常体质量组、超重组，差异有统计学意义（P<0.05）；正常体质量组、超重组、肥胖组空腹胰高血糖素/胰岛素逐渐降低，差异有统计学意义（P<0.05）；超重组、肥胖组糖负荷后各时间点胰高血糖素/胰岛素低于正常体质量组，差异有统计学意义（P<0.05）。肥胖组胰高血糖素曲线下面积大于正常体质量组、超重组，差异有统计学意义（P<0.05）。Pearson相关分析显示，空腹胰高血糖素与BmI、空腹血糖（FPG）、75 g葡萄糖负荷后2 h血糖（2 hPG）、HOmA-IR呈正相关（r=0.189、0.235、0.176、0.162，P<0.01），与ISI呈负相关（r=-0.162，P<0.01）。多元线性回归分析显示，BmI （β=0.182，t=3.252，P<0.01）、FPG（β=0.150，t=2.158，P<0.05）是空腹胰高血糖素的影响因素。结论2型糖尿病患者随BmI增加，胰高血糖素水平升高，胰岛α细胞功能紊乱，胰岛素抵抗加重。
목적：비교불동체질지수（BmI）2형당뇨병환자이고혈당소、이도소수평적변화。방법선택2013년5월—2014년5월우천진의과대학대사병의원주원적2형당뇨병환자328례위연구대상，안BmI분위정상체질량조、초중조、비반조，행구복포도당내량시험급이도소、이고혈당소석방시험，비교불동BmI조간이고혈당소곡선하면적、이고혈당소/이도소비치적변화。결과정상체질량조、초중조、비반조이도소저항지수（ HOmA-IR）、이도β세포공능지수（HOmA-β）、조기이도소분비지수（ΔI30/ΔG30）의차승고，이도소민감성지수（ISI）의차강저，조간량량비교차이균유통계학의의（ P<0.05）。비반조공복급당부하후30 min이고혈당소수평고우정상체질량조、초중조，차이유통계학의의（P<0.05）；정상체질량조、초중조、비반조공복이고혈당소/이도소축점강저，차이유통계학의의（P<0.05）；초중조、비반조당부하후각시간점이고혈당소/이도소저우정상체질량조，차이유통계학의의（P<0.05）。비반조이고혈당소곡선하면적대우정상체질량조、초중조，차이유통계학의의（P<0.05）。Pearson상관분석현시，공복이고혈당소여BmI、공복혈당（FPG）、75 g포도당부하후2 h혈당（2 hPG）、HOmA-IR정정상관（r=0.189、0.235、0.176、0.162，P<0.01），여ISI정부상관（r=-0.162，P<0.01）。다원선성회귀분석현시，BmI （β=0.182，t=3.252，P<0.01）、FPG（β=0.150，t=2.158，P<0.05）시공복이고혈당소적영향인소。결론2형당뇨병환자수BmI증가，이고혈당소수평승고，이도α세포공능문란，이도소저항가중。
Objective To compare glucagon level and insulin level among type 2 diabetic patients with different body mass index ( BmI ). Methods We enrolled 328 patients with type 2 diabetes mellitus who were admitted into metabolic Diseases Hospital of Tianjin medical University from may 2013 to may 2014. According to BmI,the patients were divided into three groups:normal BmI group,overweight group,obesity group. The oral glucose tolerance test( OGTT)and the glucagon release test were undertaken,and comparison was made in area under the curve( AUC)of glucagon and glucagon/insulin ratio among the three groups. Results The normal BmI group was lowest in HOmA-IR,HOmA-βandΔI30/ΔG30 and highest in ISI,followed by the overweight group and the obesity group with the differences significant(P<0. 05). The obesity group was higher than normal BmI group and overweight group in 30 min after glucagon load ( P <0. 05 ). The normal BmI group was highest in fasting glucagon/insulin ratio,followed by the overweight group and obesity group with the differences significant( P<0. 05),and the overweight group and the obesity group were lower(P<0. 05)than the normal BmI group in glucagon/insulin ratio at each time point after glucose load. The obesity group was higher(P<0. 05)than the normal BmI group and overweight group in AUC of glucagon. The Pearson correlation analysis showed that fasting glucagon was positively correlated with BmI, FPG,2 hPG and HOmA - IR(r =0. 189,0. 235,0. 176,0. 162,P <0. 01)and negatively correlated with ISI(r =-0. 162,P<0. 01). multiple regression analysis showed that,BmI(β =0. 182,t =3. 252,P <0. 01)and FPG(β =0. 150,t=2. 158,P<0. 05)were the influencing factors for fasting glucagon. Conclusion Higher BmI of type 2 diabetic patients is associated with higher glucagon level,dysfunction of insulin α-cell and severer insulin resistance.