2型糖尿病患者胰岛素强化治疗后胰岛功能的变化

目的探讨2型糖尿病（T2DM）患者胰岛功能受损可能的机制。方法40例T2DM患者（T2DM组）及19名健康人（对照组）行口服75g葡萄糖耐量试验（OGTT），于0、30、120min取静脉血，分别测定空腹及OGTT后30、120min血糖、胰岛素、C肽、胰高血糖素（GLC）、生长抑素的水平。T2DM组予胰岛素强化治疗，治疗后复测上述项目。结果①T2DM组治疗前后各时点血糖均高于对照组（均P〈0．01）。T2DM组治疗后空腹及OGTT后30min血糖均低于治疗前（7．8＋0．5）mmol／L比（12．0＋1．7）mmol／L，（19．6±4．7）mmol／L比（23．4±5．8）mmol／L，P〈0．05或P〈0．01]。②T2DM组治疗前后空腹及OGTT后30min胰岛素均低于对照组，且OGTT后120min胰岛素高于对照组（P〈0．05或P〈0．01）。T2DM组治疗后OGTT后120min胰岛素高于治疗前（175±88）pmol／L比（129±58）pmol／L，P〈0．01]。T2DM组治疗前后各时点C肽均低于对照组（均P〈0．01）。③T2DM组治疗前后各时点GLC均高于对照组且均低于治疗前（均P〈0．01）。④T2DM组治疗前后空腹及OGTF后120min生长抑素均高于对照组（89±9）、（89±8）ng／L比（83±12）ng／L，（107±14）、（109±12）ng／L比（964-16）ng／L]，OGTT后30min生长抑素低于对照组（110±13）、（109±13）ng／L比（119±19）ng／L]，差异均有统计学意义（P〈0．05或P〈0.01）。结论T2DM患者胰岛β细胞分泌水平较正常人明显下降；α细胞功能紊乱，GLC分泌不受高血糖抑制；γ细胞分泌功能紊乱，分泌高峰缺失。短期强化治疗能改善患者的血糖控制、β细胞功能与α细胞功能，对γ细胞无明显改变。

Metergasis of pancreas on type 2 diabetes mellitus patients after intensive insulin therapy

Objective To monitor the serum insulin （ INS）, C-peptide （ C-P）, glucagon （GLC） and somtostatin （SS） levels among the type 2 diabetes mellitus （T2DM） patients receiving intensive insulin therapy in order to find out pathogenesis of T2DM. Methods All 40 T2DM patients and 19 healthy subjects were divided into T2DM group and NC group. All subjects had been fasting for 10 hours, and received oral 75 g glucose at 07：00. Then blood glucose, serum insulin, C-peptide, glueagon and somtostatin level was sampled at baseline, 30 minutes and 120 minutes post oral glucose intake. The levels of blood glucose, INS, C-P, GLC and SS were compared a- mong the 2 groups statistically. The T2DM had been examined again after intensive insulin therapy. Results ①Compared to NC group, the levels of blood glucose at 0,30,120 rain increased significantly in T2DM group before treatment and after treatment（ all P 〈 0.01 ）. After treatment, the levels of Go, G30 in T2DM group were lower than those before treatment （7.8 ± 0.5 ） mmol/L vs （ 12.0 ± 1.7 ） retool/L, （ 19.6 ± 4.7 ） mmol/L vs （ 23.4 ± 5.8 ） mmol/L, P 〈0.05 or P 〈0.01 ]. ②Before and after treatment, the levels of INS0, INS30 in T2DM group were lower than those in NC group,and the levels of INSI2o were higher than those in NC group （P 〈0.05 or P 〈0.01 ）. The levels of INS120 after treatment were higher than those before treatment in T2DM group （ 175 ± 88 ）pmol/L vs （ 129 ± 58 ） pmol/L, P 〈 0.01 ]. Compared to NC group, the levels of C-P in T2DM group before and after treatment were lower（ all P 〈 0.01 ）. ③Before and after treatment, the levels of GLC in T2DM group were higher than those in NC group, and the levels of GLC after treatment were lower than those before treatment in T2DM, and there were significant differences（ all P 〈 0.01 ）. ④Before and after treatment, the levels of SSo, SS120 in T2DM group were higher than those in NC group （89 ±9） ,（89 ± 8） ng/L vs （83 ± 12）ng/L,（107 ±14）,（109 ± 12） ng/L vs（96 ± 16）ng/L], and the levels of SS30 were lower than those in NC group （ 110 ± 13 ）, （ 109 ± 13 ）ng/L vs （ 119 ± 19 ）ng/L ] , and there were significant differences（P 〈 0.05 or P 〈 0.01 ）. Conclusions The β-cell function is damaged in T2DM patients. The α-cell function is impaired and GLC can not be restrained by hyperglycaemia. The γ-cell function is impaired and secretion peak is deficient. Short-time intensive insulin therapy can improve β-cell and α-cell function.