南方医科大学学报

南方医科大学学报 ›› 2019, Vol. 39 ›› Issue (09): 1003-.doi: 10.12122/j.issn.1673-4254.2019.09.01

• •    下一篇

糖化血红蛋白和病程对2 型糖尿病胰岛β细胞功能的影响

何银辉，徐海燕，付麒，杨涛   

  • 出版日期:2019-09-20 发布日期:2019-09-20

Effects of glycosylated hemoglobin and disease course on islet β-cell function in patients with type 2 diabetes

  • Online:2019-09-20 Published:2019-09-20

HTML

PDF

1718

摘要： 目的比较不同糖化血红蛋白（HbA1c）水平、不同病程的2型糖尿病患者胰岛β细胞功能的差异。方法2014年12月~2016 年4月于南京医科大学第一附属医院内分泌科住院的803例2型糖尿病患者作为研究对象，测定人体参数、生化指标、胰岛自身 抗体，并行馒头餐试验评估患者的胰岛β细胞功能及胰岛素抵抗。结果二者线性相关分析发现2 型糖尿病患者HbA1c 与 HOMA2-IR、HOMA2-%β、DI30、DI180 均呈负相关（P=0.000），病程与HOMA2-IR、HOMA2-%β、DI180 均呈负相关（P<0.05）。 将患者依据HbA1c水平分为3组，3组间HOMA2-IR、HOMA2-%β、DI30和DI180均有统计学差异（P=0.000），低HbA1c水平组 （HbA1c≤7.8%）患者HOMA2-%β、DI30、DI180 明显高于其他2 组，而高HbA1c 水平组（HbA1c>9.8%）HOMA2-%β明显下降。 将患者按病程分为3组，协方差分析显示3组间HOMA2-IR、HOMA2-%β、DI30、DI180均有统计学差异（P=0.000），随着病程延 长，DI30、DI180逐步下降。多元线性回归分析显示，HbA1c、糖尿病病程和体质量指数是2型糖尿病胰岛β细胞功能的独立影响 因素。结论随着HbA1c水平的升高或病程的延长，2型糖尿病患者胰岛β细胞分泌功能均逐渐下降。HbA1c明显升高时，患者 胰岛β细胞分泌功能明显下降，而病程明显延长时，患者胰岛β细胞分泌功能并未急速下降。

Abstract: Objective To compare islet β-cell function in type 2 diabetic (T2DM) patients with different glycosylated hemoglobin (HbA1c) levels and diabetes durations. MethodsWe examined body parameters, biochemical profiles and islet autoantibodies in a total of 803 T2DM patients admitted in the Department of Endocrinology of the First Affiliated Hospital of Nanjing Medical University between December, 2014 and April, 2016. The patientswere stratified by HbA1c level and disease course and underwent steamed bun test to evaluate islet β-cell function and insulin resistance. Results Linear correlation analysis showed that in T2DM patients, HbA1c level was negatively correlated with HOMA2-IR, HOMA2-%β, DI30 and DI180 (P=0.000), and disease course was negatively correlated with HOMA2-IR, HOMA2-% β, and DI180 (P<0.05). The patients with different HbA1c levels showed significantly different HOMA2-IR, HOMA2-%β, DI30 and DI180 (P=0.000); HOMA2-%β, DI30 and DI180 were significantly higher in patients with HbA1c levels <7.8%, and HOMA2-% β was significantly decreased in patients with HbA1c levels above 9.8%. The patients with different disease courses also had significant differences in HOMA2-IR, HOMA2-%β, DI30, and DI180 (P=0.000), and as the disease course extended, DI30 and DI180 tended to decrease progressively. Multivariate linear regression analysis showed that HbA1c, diabetes duration, and body mass index (BMI) were all independent factors affecting islet β- cell function in T2DM patients. Conclusion The secretion function of islet β cells decreases progressively with the increase ofHbA1c level or disease course in T2DMpatients, but the disease course does not appear to have an effect as strong as that ofHbA1c level on islet β cell function.