2型糖尿病患者血管紧张素Ⅱ与胰岛β细胞分泌功能的关系探讨

目的 探讨不同糖耐量状态下血管紧张素Ⅱ与胰岛β细胞分泌功能的关系.方法 新诊断2型糖尿病患者42例(DM组)、空腹血糖受损/糖耐量受损者38例(IFG/IGT组)、正常对照者40名(NGT组)行静脉葡萄糖耐量试验,ELISA法测定空腹血管紧张素Ⅱ(AngⅡ)及脂联素水平.计算急性胰岛素分泌反应(AIR3-10)、第一时相(0～10min)胰岛素分泌曲线下面积(AUCⅠ)及峰值浓度、第二时相(10～120min)胰岛素分泌曲线下面积(AUCⅡ)、稳态模型评估胰岛β细胞功能指数(HOMA-β)及胰岛素抵抗指数(HOMA-IR).探讨AngⅡ与AIR3-10、AUCⅠ及峰值浓度、AUCⅡ、脂联素、HOMA-β及HOMA-IR的关系.结果 (1)DM组和IFG/IGT组AngⅡ显著高于NGT组(P＜0.05);DM组和IFG/IGT组AIR3-10、AUCⅠ及峰值浓度、AUCⅡ、脂联素显著低于NGT组(P＜0.05),DM组降低更为显著;(2)AngⅡ与AIR3-10、AUCⅠ及峰值浓度、AUCⅡ、脂联素、HOMA-β呈显著负相关(P＜0.01),与空腹血糖、糖负荷后2 h血糖、空腹胰岛素、HOMA-IR呈正相关(P＜0.05);(3)多元逐步回归分析,AngⅡ与AUCⅠ、AUCⅡ独立相关.结论 AngⅡ为胰岛β细胞分泌功能的独立影响因素.排除血压、体位、药物等因素的影响,高AngⅡ水平可预测2型糖尿病患者胰岛β细胞功能受损及胰岛素抵抗.

Abstract：

Objective To investigate the relationship between angiotensin Ⅱ and pancreatic islet β cell secretion function under different glucose tolerance statuses. Method Forty-two patients with newly diagnosed type 2diabetes mellitus ( DM group), 38 subjects with impaired fasting glucose/impaired glucose tolerance ( IFG/IGTgroup) ,and 40 normal control subjects (NGT group) underwent intravenous glucose tolerance test. Fasting plasma angiotensin Ⅱ ( Ang Ⅱ ) and adiponectin were assayed by ELISA. Acute insulin response from 3 to 10 min( AIR3-10 ),the area under the curve( AUCⅠ ) and the peak concentration of the first-phase ( 0-10 min) insulin secretion, the area under the curve of the second-phase( 10-120 min) insulin secretion( AUCⅡ), homeostasis model assessment for β cell function index(HOMA-β) and homeostasis model assessment for insulin resistance index(HOMA-IR) were calculated to explore the relationship with Ang Ⅱ. Result ( 1 ) The levels of Ang Ⅱ in DM group and IFG/IGT group were significantly higher than that in NGT group( P＜0.05 ). The AIR3-10, AUCⅠ and peak concentration, AUCⅡ ,adiponectin in DM group and IFG/IGT group were significantly lower than those in the NGT group ( P＜0. 05), and these results were more significantly reduced in DM group compared with those in IFG/IGT group. (2) Ang Ⅱ was negatively correlated with AIR3-10, AUCⅠ and the peak concentration, AUCⅡ, adiponectin, HOMA-β ( P＜0. 01 ), and positively correlated with fasting blood glucose,2 h blood glucose after glucose loading, fasting insulin, HOMA-IR (P＜0. 05 ). (3)Multiple stepwise regression analysis showed that Ang Ⅱ was independently associated with AUCⅠ and AUCⅡ.Conclusion Ang Ⅱ was an independent factor that affected the insulin secretion function of pancreatic islet βcells. Ruling out the effect of blood pressure, body position, drugs, and other factors, high levels of Ang Ⅱ could predict the dysfunction of pancreatic islet β cell as well as insulin resistance in patients with type 2 diabetes.