丁宇; 付麒; 秦瑶; 孙敏; 杨涛

doi:10.3760/cma.j.cn115791-20200403-00185

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2‌型糖尿病患者C肽评估胰岛β细胞功能随病程变化的分析

中华糖尿病杂志, 2020,12(7) : 491-495. DOI: 10.3760/cma.j.cn115791-20200403-00185

摘要

目的

探讨2‌型糖尿病（T2DM）患者C肽评估胰岛β细胞功能随病程变化的特点及其相关因素。

方法

选取2014‌年11‌月至2018‌年5‌月于南京医科大学第一附属医院内分泌科住院的T2DM患者1 570‌例，男970‌例，女600‌例，年龄12~88（58±12）岁，糖尿病病程3 d至34（8.3±7.2）年。将患者按照病程进行分组，分别为糖尿病病程≤1‌年组340‌例，1‌年<病程≤5‌年组325‌例，5‌年<病程≤15‌年组650‌例，病程>15‌年组255‌例。采用ANOVA法比较不同病程患者组间的C肽释放指数（CRI）水平。在病程分组基础上，再分别以糖化血红蛋白（HbA_1c）和25羟维生素D［25（OH）D］中位数进行分组，采用独立样本t检验比较各亚组间的CRI水平。采用Pearson法相关分析、多重线性回归分析CRI主要相关因素。

结果

病程、HbA_1c和25（OH）D是T2DM患者CRI的主要相关因素，回归系数分别为-3.108、-17.247和0.326，P均<0.01。胰岛功能随病程延长呈现出一定的变化规律：在病程早期（病程≤5‌年），随病程增加胰岛功能缓慢下降；随着病程进一步延长，胰岛功能以每年约2%的幅度持续下降；这种下降趋势至病程22‌年后出现减弱，患者的胰岛功能再次趋向缓慢下降。HbA_1c的中位数为8.7%，将患者分为HbA_1c<8.7%和HbA_1c≥8.7%亚组；25（OH）D中位数为45.7 nmol/L，据此分为25（OH）D<45.7 nmol/L和25（OH）D≥45.7 nmol/L亚组。HbA_1c<8.7%亚组CRI均明显高于HbA_1c≥8.7%亚组，差异有统计学意义（均P<0.05）；25（OH）D分组后不同亚组间CRI差异无统计学意义（均P>0.05）。

结论

T2DM患者的胰岛β细胞功能随病程延长呈现先缓慢再加速再缓慢的下降趋势，患者CRI水平与多个因素相关。

引用本文: 丁宇, 付麒, 秦瑶, 等. 2‌型糖尿病患者C肽评估胰岛β细胞功能随病程变化的分析 [J] . 中华糖尿病杂志, 2020, 12(7) : 491-495. DOI: 10.3760/cma.j.cn115791-20200403-00185.

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随病程延长，2‌型糖尿病（type 2 diabetes melitus，T2DM）患者胰岛β细胞功能水平及相关因素管理在血糖调控、并发症进展、治疗方案确定中均具有重要意义。1985‌年Matthews等^［1］提出用稳态模型（homeostasis model assessment，HOMA）评估胰岛素抵抗及β细胞功能，利用空腹胰岛素及空腹血糖（fasting plasma glucose，FPG）来推算HOMA-β细胞功能指数，HOMA-β细胞功能指数增大，表明胰岛素分泌功能增强。而后，Levy等^［2］于1998‌年把HOMA的诸多非线性公式综合（称为HOMA2），推荐使用C肽来计算β细胞功能，用空腹胰岛素计算胰岛素抵抗及胰岛素敏感指数^［3］。C肽在体内的半衰期显著长于胰岛素，外周C肽检测结果显示其比胰岛素更稳定^［4］。目前，C肽评估胰岛功能已广泛应用于β细胞功能评估，尤其是1‌型糖尿病患者和使用外源性胰岛素的T2DM患者^{［5, 6, 7, 8］}。因此，笔者基于C肽探讨T2DM患者胰岛β细胞功能的相关因素，构建胰岛功能随病程延长的拟合图形，旨在进一步明确T2DM患者胰岛功能随病程变化的特点。

贡献者信息

丁宇

南京医科大学第一附属医院内分泌科　210029

付麒

南京医科大学第一附属医院内分泌科　210029

秦瑶

南京医科大学第一附属医院内分泌科　210029

孙敏

南京医科大学第一附属医院内分泌科　210029

杨涛

南京医科大学第一附属医院内分泌科　210029

通信作者

杨涛

南京医科大学第一附属医院内分泌科　210029

Email：yangt@njmu.edu.cn

关键词

糖尿病，2‌型; 胰岛功能; C肽释放指数;

基金项目

国家自然科学基金重点项目（81830023）

作者声明

引用本文：

丁宇, 付麒, 秦瑶, 等. 2‌型糖尿病患者C肽评估胰岛β细胞功能随病程变化的分析[J]. 中华糖尿病杂志, 2020, 12(7): 491-495. DOI: 10.3760/cma.j.cn115791-20200403-00185.

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历史

出版日期：2020-07-27

收稿日期：2020-04-03

本文编辑

张远明

Original Article

Analysis of islet beta cell function assessed by C-peptide changing with the disease duration in patients with type 2 diabetes mellitus

Ding Yu, Fu Qi, Qin Yao, Sun Min, Yang Tao

Published 2020-07-27

Cite as Chin J Diabetes Mellitus, 2020, 12(7): 491-495. DOI: 10.3760/cma.j.cn115791-20200403-00185

Abstract

Objective

To investigate the characteristics and associated factors of islet beta cell function (evaluated by C-peptide) changing with the disease duration in patients with type 2 diabetes mellitus (T2DM).

Methods

Data were collected in 1 570 hospitalized T2DM patients ［970 males and 600 females, with a mean age of (58±12) years (12 to 88 years) and diabetes duration of (8.3±7.2)years (3 d to 34 years)］ from the Department of Endocrinology, the First Affiliated Hospital of Nanjing Medical University between November, 2014 and May, 2018. According to the diabetes duration, all patients were divided into 4 groups: diabetes duration ≤ 1 year group (n=340), 1 year<diabetes duration ≤ 5 years group (n=325), 5 years<diabetes duration ≤ 15 years group (n=650) and diabetes duration>15 years group (n=255). C-peptide release index (CRI) was compared and analyzed among different groups by ANOVA. On the basis of diabetes duration grouping, CRI levels were compared by independent sample t test between subgroups grouped using the median levels of glycosylated hemoglobin A_1c (HbA_1c) and 25-hydroxyvitamin D ［25(OH)D］. The major associated factors of CRI were analyzed by using Pearson correlation analysis and multiple linear regression analysis.

Results

The major factors associated with CRI were diabetes duration, HbA_1c and 25(OH)D in T2DM, and the regression coefficients were -3.108, -17.247 and 0.326, respectively (all P<0.01). Islet function showed some regularities with the disease duration prolonged. Islet function decreased slowly in the early stage (disease duration ≤5 years), then decreased continuously in an annual rate of about 2%, and finally tended to weaken and decrease slowly again after 22 years of diabetes duration. According to the median of HbA_1c 8.7%, the patients were divided into HbA_1c<8.7% and HbA_1c≥8.7% subgroups. And the patients were assigned to 25(OH)D<45.7 nmol/L and 25(OH)D≥45.7 nmol/L subgroups on the basis of the median of 25(OH)D 45.7 nmol/L. The results showed that the CRIs in HbA_1c<8.7% subgroup were significantly higher than those in HbA_1c≥8.7% subgroup (all P<0.05), while there was no significant differences in CRIs after subgrouping by 25(OH)D (all P>0.05).

Conclusion

In T2DM patients, the islet function decreases slowly at first, then accelerates, and finally decreases slowly again with diabetes duration prolonged, and many factors are associated with CRI.

Key words:

Diabetes mellitus，type 2; Islet function; C-peptide release index

Contributor Information

Ding Yu