2型糖尿病患者空腹胰高糖素水平和胰高糖素/胰岛素比值随病程的演变

doi:10.6040/j.issn.1671-7554.0.2014.194

摘要/Abstract

摘要： 目的分析2型糖尿病患者空腹胰高糖素(FGLC)水平、空腹胰高糖素/胰岛素(FGLC/FINS)比值随病程进展的演变趋势及其与血糖控制水平的关系.方法选取2013年1月至2013年5月于山东大学齐鲁医院内分泌科住院的2型糖尿病患者262例,根据糖尿病病程分组如下:病程<5年为A组(65例),≥5年且<10年为B组(62例),≥10年且<15年为C组(46例),≥15年且<20年为D组(45例),≥20年为E组(44例),分析患者FGLC、空腹胰岛素(FINS)、FGLC/FINS比值、C肽、胰岛素抵抗指数(HOMA-IR)、胰岛素释放指数(HOMA-β)等指标与病程和空腹血糖(FBG)、糖化血红蛋白(HbA1c)的相关性.结果 FGLC在A、B、C三组随病程逐渐升高(r=0.243,P<0.05),D、E组FGLC低于C组(P<0.05)且与病程无直线相关性;FGLC/FINS比值与病程呈显著正相关(r=0.243,P<0.05);多元线性逐步回归分析示,FGLC/FINS比值与FBG和HbA1c呈正相关(t=4.474或2.212,P<0.05).结论自诊断起15年内2型糖尿病患者FGLC随病程进展逐渐升高,此后出现轻度降低,FGLC/FINS比值随病程进展呈上升趋势;FGLC/FINS比值可能是影响2型糖尿病血糖控制水平的重要因素.

关键词: 胰高糖素/胰岛素比值, 胰高糖素, 2型糖尿病, 病程

Abstract: Objective To analyze the dynamics of fasting glucagon (FGLC) and glucagon /insulin (FGLC/FINS) ratio with diabetes durations and their correlations with glycemic control in patients with type 2 diabetes. Methods Two hundred and sixty-two patients with type 2 diabetes were enrolled and divided into five groups according to diabetes duration: <5 years (group A, n=65); ≥ 5 years and <10 years (group B, n=62); ≥10 years and <15 years (group C, n=46); ≥15 years and <20 years (group D, n=45);≥20 years (group E, n=44). FGLC, fasting insulin (FINS), FGLC/FINS ratio, C peptide, HOMA-IR, HOMA-β and other metabolic indicators were measured to explore their correlations with diabetes duration, fasting blood glucose (FBG) and glycosylated hemoglobin (HbA1c). Results FGLC levels of groups A, B and C increased progressively with diabetes duration(r=0.243, P<0.05). Oppositely, FGLC levels of groups D and E were lower than that of group C (P<0.05) and were not correlated with diabetes duration. FGLC/FINS ratio was positively correlated with diabetes duration (r=0.243, P<0.05). Multiple stepwise regression analysis showed that the FGLC/FINS ratio was positively correlated with FBG and HbA1c (t=4.474 or 2.212, P<0.05). Conclusion FGLC of patients with type 2 diabetes increased with diabetes duration forthe first 15 years since being diagnosed, then slightly decreased, whereas the FGLC/FINS ratio consistently increased with diabetes duration. The FGLC/FINS ratio might significantly affect the glycemic control in patients with type 2 diabetes.

Key words: Type 2 diabetes, Glucagon, Glucagon/insulin ratio, Duration

中图分类号:

R587.1

田萌, 武传龙, 齐林, 刘燕, 王川, 赵汝星, 梁凯, 宋君, 侯新国, 陈丽. 2型糖尿病患者空腹胰高糖素水平和胰高糖素/胰岛素比值随病程的演变[J]. 山东大学学报（医学版）, 2014, 52(11): 33-37.

TIAN Meng, WU Chuanlong, QI Lin, LIU Yan, WANG Chuan, ZHAO Ruxing, LIANG Kai, SONG Jun, HOU Xinguo, CHEN Li. Dynamics of fasting glucagon and fasting glucagon /insulin ratio with diabetes duration in patients with type 2 diabetes[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2014, 52(11): 33-37.

参考文献

[1] DAlessio D. The role of dysregulated glucagon secretion in type 2 diabetes[J]. Diabetes Obes Metab, 2011, 13(1):126-132.
[2] Kaku K, Kawasaki F, Kanda Y, et al. Retained capacity of glucose-mediated insulin secretion in patients with type 2 diabetes mellitus inversely correlates with the duration of diabetes[J]. Diabetes Res Clin Pract, 2004,64(3):221-223.
[3] Wallace T M, Levy J C, Matthews D R. Use and abuse of HOMA modeling[J]. Diabetes Care, 2004, 27(6):1487-1495.
[4] Ramnanan C J, Edgerton D S, Kraft D, et al. Physiologic action of glucagon on liver glucose metabolism[J]. Diabetes Obes Metab, 2011, 13(1):118-125.
[5] Lee Y, Berglund E D, Wang M Y, et al. Metabolic manifestations of insulin deficiency do not occur without glucagon action[J]. Proc Natl Acad Sci U S A, 2012,109(37):14972-14976.
[6] Fridlyand L E, Philipson L H. A computational systems analysis of factors regulating α cell glucagon secretion[J]. Islets, 2012, 4(4):262-283.
[7] Walker J N, Ramracheya R, Zhang Q, et al. Regulation of glucagon secretion by glucose: paracrine, intrinsic or both?[J]. Diabetes Obes Metab, 2011, 13(1):95-105.
[8] Kawamori D, Kulkarni R N. Insulin modulation of glucagon secretion: the role of insulin and other factors in the regulation of glucagon secretion[J]. Islets, 2009, 1(3):276-279.
[9] Menge B A, Grüber L, Jrgensen S M, et al. Loss of inverse relationship between pulsatile insulin and glucagon secretion in patients with type 2 diabetes[J]. Diabetes, 2011, 60(8):2160-2168.
[10] Christensen M, Vedtofte L, Holst J J, et al. Glucose-dependent insulinotropic polypeptide:a bifunctional glucose-dependent regulator of glucagon and insulin secretion in humans[J]. Diabetes, 2011, 60(12):3103-3109.
[11] 项守奎, 朱大龙. α细胞、胰高血糖素与2型糖尿病[J]. 医学研究生学报, 2010, 23(4): 440-443. XIANG Shoukui, ZHU Dalong. Alpha-cells, glucagon and type 2 diabetes[J]. J Med Postgra, 2010, 23(4):440-443.
[12] Shen X X, Li H L, Pan L, et al. Glucotoxicity and α cell dysfunction: involvement of the PI3K/Akt pathway in glucose-induced insulin resistance in rat islets and clonal αTC1-6 cells[J]. Endocr Res, 2012, 37(1):12-24.
[13] 杜瑞琴, 李宏亮, 杨文英, 等. 吡格列酮对胰岛α细胞胰岛素抵抗的影响[J]. 中华内分泌代谢杂志, 2008,24(1):29-33. DU Ruiqin, LI Hongliang, YANG Weiying, et al. Effect of pioglitazone on islet α cell with respect to insulin resistance[J]. Chin J Endocrinol Metab, 2008, 24(1): 29-33.
[14] Gosmain Y, Masson M H, Philippe J. Glucagon: the renewal of an old hormone in the pathophysiology of diabetes[J]. J Diabetes, 2013, 5(2): 102-109.
[15] 郭航, 常宝成, 杨菊红, 等. 不同病程2型糖尿病患者胰岛α及β细胞功能评价[J]. 中华全科医师杂志, 2013,12(11):874-877. GUO Hang, CHANG Baocheng, YANG Juhong, et al. Functions of pancreatic islet a-cells and β-cells in different disease courses of type 2 diabetes mellitus[J]. Chin J Gen Pract, 2013, 12(11):874-877.
[16] 孙晔子, 王粹芳, 崔世维. 胰高血糖素在2型糖尿病发展中的作用探讨[J]. 山西医药杂志, 2008, 37(12):1119-1121.
[17] Zhang Y, Hu G, Yuan Z, et al. Glycosylated hemoglobin in relationship to cardiovascular outcomes and death in patients with type 2 diabetes: a systematic review and meta-analysis[J]. PLoS One, 2012, 7(8):e42551. doi: 10.1371/journal.pone.0042551.
[18] 袁岩, 顾海军, 钱燕宁. 糖化血红蛋白与糖尿病并发症相关性的研究进展[J]. 实用临床医药杂志, 2011, 15(19):186-189.

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