2型糖尿病患者血糖、血脂、氧化应激与β细胞功能的相关性研究

摘要

目的 探讨不同糖耐量个体血糖、血脂及氧化应激与胰岛β细胞第一时相分泌功能的关系.方法 纳入新诊断2型糖尿病患者(T2DM组)40例,糖耐量减低者(IGT组)37例,糖耐量正常者(NGT组)43例.分别行静脉葡萄糖耐量试验(IVGTT),测定血糖、血脂、8-羟基脱氧尿苷(8-OHdG)、丙二醛(MDA)、超氧化物歧化酶(SOD)、空腹胰岛素(FINS)等.计箅0～10min胰岛素曲线下面积(AUC)、急性胰岛素反应3-5(AIR3-5)、稳态模型胰岛素抵抗指数(HOMA-IR)及稳态模型胰岛素分泌指数(HOMA-B).分析氧化应激指标与空腹血糖(FPG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG)、总胆固醇(TC)、AUC、AIR3-5、HOMA-IR及HOMA-B的关系.结果 IGT组、T2DM组SOD、AIR3-5、AUC显著低于NGT组(P<0.05).IGT组、T2DM组LDL-C、TG、8-OHdG 和MDA显著高于NGT组(P<0.05).IGT组SOD、AIR3-5,AUC显著低于T2DM组(P<0.05),而LDL-C、TG、8-OHdG 和MDA则显著高于T2DM组(P<0.05).MDA、8-OHdG与FPG、TG、LDL-C呈正相关,与FINS、HOMA-B、AUC、AIR3-5呈负相关;SOD与FINS、HOMA-B、AUC、AR3-5呈正相关,与FPG、TG、LDL-C呈负相关.多元逐步同归分析显示,8-OHdG、SOD的独立影响因素是FPG、LDI;C;且8-OHdG、SOD是AIR3-5的独立影响因素.结论 T2DM患者存在明显的糖脂代谢紊乱以及氧化应激,氧化应激对胰岛β细胞第一时相分泌功能有显著影响,可能与T2DM的发病机制相关.%Objective To investigate the relationship between glucose. lipid, oxidative stress and first-phase of pancreatic β-cell insulin secretion in individuals with different degrees of glucose tolerance. Methods The intravenous glucose tolerance test (IVGTT) was performed in 40 patients with newly diagnosed type 2 diabetes mellitus (DM group), 37 patients with impaired glucose tolerance (IGT group) , and 43 subjects with normal glucose tolerance (NGT group) . Glucose, lipid, fasting plasma 8-hydroxydeoxyguanosin (8-OHdG),malondialdehyde (MDA) and the activity of superoxide dismutase (SOD) were measured. 0-10 minutes of insulin area under the curve (AUC), acute insulin response (AIR3-5, homeostasis model assessment (HOMA-IR) and homeostasis model assessment-B (HOMA-B)were calculated to analyze the relationship between oxidative stress and the fasting plasma glucose (FPG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), triglyceride (TG), total cholesterol (TC),AUC, AIR3-5, HOMA-B and HOMA-IR. Results SOD, AIR3-5 and AUC were significantly lower in DM and IGT group than in NGT group ( P＜0.05) ; LDL-C,TG, 8-OHdG and MDA were significantly higher in IGT and DM group than in NGT group ( P＜0.05) ; SOD, AIR3-5 and AUC were significantly lower in DM group than in IGT group ( P＜0.05) ; LDL-C, TG, 8-OHdG and MDA were significantly higher in DM group than in IGT group ( P＜0. 05). MDA and 8-OHdG were positively correlated with FPG, TG and LDL-C, and negatively correlated with FINS, HOMA-B, AUC and AIR3-5. SOD was positively correlated with FINS, HOMA-B, AUC and AIR3-5, and negatively correlated with FPG, TG and LDL-C. Multiple stepwise regression analysis showed that FPG and LDL-C were the independent factors of plasma 8 OHdG and SOD, while 8-OHdG and SOD were the independent factors of AIR3-5. Conclusion Patients with type 2 diabetes have obvious glycometabolic disorder, lipoidosis and oxidative stress. Oxidative stress takes a significant effect on the first phase of pancreatic β cell insulin secretion, which may contribute to the pathogenesis of type 2 diabetes.