2型糖尿病患者残余β细胞功能与代谢控制及慢性并发症的关系

摘要

目的 探讨2型糖尿病(Type 2 diabetes mellitus,T2DM)患者残余β细胞功能与代谢控制及慢性并发症之间的关系.方法 选取2015年5月-2016年5月在新疆某三甲医院就诊并确诊为T2DM的患者714例,其中男性407例,女性307例,根据血清空腹C-肽的三分位数由低到高分为C-P1组(<1.73 ng/mL)、C-P2组(1.73～3.52 ng/mL)和C-P3组(≥3.53 ng/mL),比较3组一般资料、生理生化指标及相关并发症的发病情况,并分析血清C-肽水平与各代谢指标的相关性.结果 C-P1组T2DM诊断年龄、体质指数(Body Mass Index,BMI)、收缩压、舒张压、甘油三酯(Triacylglyceride,TG)水平显著低于C-P3组(P<0.05),而T2DM病程、糖化血红蛋白(HbAIc)、HDL-C水平及糖尿病视网膜病变的发病率显著高于C-P3组(P<0.05),而冠状动脉疾病、代谢综合征、脂肪肝发病率显著低于C-P3组(P<0.05).在调整了相关因素后,血清空腹C-肽是糖尿病视网膜病变发生的保护因素,是冠状动脉疾病、代谢综合征、脂肪肝发生的危险因素.结论 高水平的C-肽有利于控制血糖,降低糖尿病视网膜病变的发病率,而增加糖尿病冠状动脉疾病、代谢综合征和脂肪肝的发病率.%Objective To investigate the relationship between residualβcell function,metabolic control and complication in patients with type 2 diabetes mellitus (T2DM).Methods A total of 714 patients diagnosed as T2DM in a top three hospital in Urumqi,were collected and randomly divided into C-P1 (< 1.73 ng/mL),C-P2 (1.73～3.52 ng/mL)and C-P3 group (≥3.53 ng/mL)according to the trigeminality of serum fasting C-peptide and their the general physiological and biochemical indexes and related complications were compared.Results The diagnosis of age,body mass index (BMI),systolic blood pressure,diastolic blood pressure and triglyceride (TG)were significantly lower in group C-P1 than that in group C-P3 (P <0.05),while the incidence of T2DM,glycosylated hemoglobin (HbAIc),high density lipoprotein (HDL-C)and the incidence of diabetic retinopathy was significantly higher than those of C-P3 group (P <0.05). The incidence of coronary artery disease,metabolic syndrome and fatty liver were significantly lower than those of C-P3 group (P <0.05).After adjusting the related factors,serum fasting C-peptide was shown to be the protective factor of diabetic retinopathy,and be the risk factor of coronary artery disease,metabolic syndrome and fatty liver.Conclusion High level of C-peptides was observed to be beneficial for controlling blood sugar,reducing the incidence of diabetic retinopathy,and increasing the incidence of diabetes,coro-nary artery disease,metabolic syndrome,and fatty liver.