C肽和胰高血糖素测定对肝源性糖尿病的临床意义

目的探讨C肽释放试验及胰高血糖素测定对肝源性糖尿病(HD)的临床意义。方法对102例HD、95例2型糖尿病(T2DM)及110例正常对照者(NC)行葡萄糖耐量试验,测定不同时间点血糖、胰岛素、C肽及胰高血糖素水平。采用稳态模型法的胰岛β细胞功能(Homa-β)、同样方法的胰岛素抵抗指数(Homa-IR)及空腹血糖/空腹胰岛素(FPG/FINS)来评估胰岛素抵抗,用胰岛素敏感指数(ISI)评估胰岛素敏感性。结果 HD组FPG低于T2DM组(P<0.05),胰岛素分泌呈高峰延迟型,60、120 min胰岛素及C肽高于T2DM组(P<0.05)。HD组Homa-β及ISI高于T2DM组,FPG/FINS低于T2DM组(P均<0.05)。T2DM组Homa-IR高于NC组,ISI低于NC组(P均<0.05)。HD组胰高血糖素水平高于NC组及T2DM组(P<0.05),60 min达到高峰,180 min恢复正常。结论 C肽释放试验及胰高血糖素测定对鉴别HD有一定价值,对肝细胞损伤程度的判定及预后有一定的临床意义。

Clinical significance of glucagon and C-peptide in patients with hepatogenic diabetes

Objective To explore the clinical significance of glucagon and C-peptide in the patients with hepatogenic diabetes(HD).Methods Oral glucose tolerance test(OGTT) was carried out on patients with HD(n =102,Group HD) and type 2 diabetes(T2DM)(n = 95,Group T2DM) and on normal controls(n = 110,Group NC).Plasma glucose,insulin,C-peptide and glucagon were measured.Homeostatic model assessment-β(HOMA-β) was used to evaluate islet beta cell function.HOMA-IR(insulin resistance) and fasting plasma glucose(FPG) /fasting insulin of serum(FINS) were used to assess insulin resistance.Insulin sensitivity index(ISI) was measured to assess insulin sensitivity.Results The FPG level of Group HD was lower than that of Group T2DM(P < 0.05).A delayed insulin peak was showed in Group HD whose insulin and C-peptide levels at 60-and 120 min were higher than that of Group T2DM(P < 0.05).HOMA-β and ISI were higher and FPG / FINS was lower in Group HD than in Group T2DM(P < 0.05).HOMA-IR was higher and ISI was lower in Group T2DM than in Group NC(P < 0.05).The glucagon level of Group HD was higher than that of both Group T2DM and Group NC(P < 0.05),and it reached its peak at 60 min and returned to original level after 180 min.Conclusion C-peptide release test,as well as the level of glucagon,play a key role in the diagnosis of hepatic diabetes and in the judgement of liver cirrhosis.