血清胰岛素、胰升血糖素水平及胰岛素／胰升血糖素比值与糖代谢状态的相关性研究

摘要

Objective To investigate the relationship between serum insulin ,glucagon levels and insulin/glucagon ratios and different glucose intolerance status. Methods 81 patients with newly diagnosed type 2 diabetes (T2DM) ,35 with impaired glucose regulation (IGR) and 38 with normal glucose tolerance (NGT) were enrolled. All subjects received 75 g oral glucose tolerance test with measurement of plasma glucose ,insulin and glucagon at fasting and 0.5 h ,1 h ,2 h and 3 h. Results There was no difference on fasting insulin among NGT ,IGR and T2DM group. Compared with NGT or IGR ,T2DM had lower insulin levels at 0.5 h and 1 h after glucose load(P<0.01). IGR had higher insulin level at 2 h than NGT group(P<0.05). The area under the curve(AUC) of insulin was larger in IGR group than in DM group(P<0.01). T2DM patients had higher level of glucagon at fasting ,0.5 h ,1 h and 2 h compared with NGT or IGR.T2DM had the largest AUC of glucagon among three groups(P<0.05). The ratio of insulin to glucagon at fasting ,0.5 h and 1 h were lower in T2DM group than in NGT and IGR group.The AUC of glucagon was positively associated with body weight ,waist ,BMI ,HbA1c ,serum creatinine and uric acid (P<0.05). Conclusion Glucagon secretion is impaired in T2DM patients accompanying with beta cell dysfunction. The ratio of insulin to glucagon may be a better parameter reflecting the pancreatic alpha and beta cell dysfunction.%目的：探讨胰岛素（Ins）、胰升血糖素（Glu）和 Ins／Glu比值与不同糖代谢状态的相关性。方法选取T2DM患者（T2DM组）81例、IGR患者（IGR组）35例及糖耐量正常（NGT组）者38名，均行75 g OGT T或标准馒头餐试验，分别测定各时点血糖、Ins和Glu水平。结果各组FIns水平比较，差异无统计学意义（P＞0.05）。T2DM组0.5 hIns、1 hIns水平低于NGT和IGR组，IGR组2 hIns水平高于NGT组（P＜0.01或 P＜0.05）。IGR组胰岛素曲线下面积（AUCi ）较 T2DM 组升高（P＜0.01）。除3 h外，T2DM组空腹及糖负荷后各时点Glu水平均高于NGT组和IGR组。T2DM组AUCglu较NGT组和IGR组增大（P＜0.05）。 T2DM 组空腹、0.5 h及1 hIns／Glu比值均低于 NGT 组和 IGR组（P＜0.05）。AUCglu与体重、WC、BMI、HbA1c、Scr及SUA水平呈正相关（P＜0.01）。结论 Glu分泌紊乱是T2DM患者胰岛功能受损的重要表现。应用 Ins／Glu比值能更好的反映胰岛α及β细胞功能异常情况。