精氨酸刺激试验评估糖尿病患者第一相胰岛素分泌功能的临床价值

摘要

Objective To investigate clinical value of arginine stimulation test to estimate the first-phase insulin release of pancreatic isletβ-cell and evaluation indicators of insulin release.Methods Choose inpatients with diabetes in the department of endocrinology,divide into type 1 diabetes mellitus group (T1DM group)12 cases,type 2 diabetes mellitus group a (T2DMa group,duration of no more than 1 year)57 cases and type 2 diabetes mellitus group b (T2DMb group,more than 1 year),82 cases.Theserum levels of blood glucose (PG),insulin (INS)and C-peptide (CP)were determined at fasting 0 mi-nutes and 2,4,6 minutes after arginine stimulation,and process the results statistically.Results After arginine stimulation, three groups of PG and the T1DM group of INS and CP had no obvious change and there were no statistical significance (F=0.150~0.696,P>0.05).In T2DMa group and T2DMb group,the peak level of INS and CP appeared at 2nd minute,and those in T2DMa group were higher than those in T2DMb group and these were statistical significance (F=12.145~40.518,P<0.01).The serum levels of INS and CP decreased gradually at 4,6 mintues,but still higher than those of 0 mint-ues.△INS and △CP in T2DMa group were higher than those in T2DMb group,those in T2DMb group were higher than those in T1DM group,and these were statistical significance (F=11.022~10.387,P<0.01).In T1DM group,△INS and△CP had no correlation (r=0.428,P>0.05).In T2DMa and T2DMb groups,those had positive correlation (r=0.768, 0.722,P<0.01).Conclusion Arginine stimulation test can be sensitively estimated the first-phase insulin release of pancre-atic isletβ-cell and that has certain clinical application value.△INS and △CP can be used to evaluating insulin release.%目的：探讨精氨酸刺激试验评估糖尿病患者胰岛β细胞第一相分泌功能的临床价值及该试验评估胰岛分泌功能的判断指标。方法选择内分泌科住院糖尿病患者，分1型糖尿病组（T1DM组）12例；2型糖尿病 a组（T2DMa组，病程≤1年）57例；2型糖尿病 b组（T2DMb组，病程＞1年）82例。测定三组的空腹0 min与精氨酸刺激后2，4，6 min时血糖（PG）、胰岛素（INS）和C肽（CP），结果进行统计学分析。结果精氨酸刺激后，三组 PG以及 T1DM组 INS和 CP均无明显变化，差异无统计学意义（F＝0.150～0.696，P值均＞0.05）；T2DMa组和 T2DMb组 INS和 CP均在2 min达峰值，且峰值T2DMa组＞T2DMb组，差异有统计学意义（F＝12.145～40.518，P 值均＜0.01），4，6 min 逐渐下降，但仍高于0 min。同时组间△INS和△CP的值以 T2DMa组＞T2DMb组＞T1DM组，差异有统计学意义（F＝11.022～10.387，P 值均＜0.01）。T1DM组△INS和△CP无相关性（r＝0.428，P＞0.05），T2DMa组和T2DMb组△INS和△CP均呈正相关（r＝0.768，0.722，P值均＜0.01）。结论精氨酸刺激试验能敏感地评估糖尿病患者胰岛β细胞第一相分泌功能，有一定的临床应用价值，同时△INS和△CP均可作为该试验评估胰岛第一相分泌功能的判断指标。