2型糖尿病和糖调节异常患者胰岛α、β细胞功能的变化

摘要：目的  探讨2型糖尿病（T2DM）和糖调节异常（IGR）患者胰岛α、β细胞功能的变化。方法  选取2014年4月-2016年4月在该院就诊的T2DM和IGR患者120例。其中，T2DM患者68例（T2DM组），IGR患者52例（IGR组），同时选取健康体检者40例作为对照组，观察各组空腹状态下胰岛素稳态模型分泌指数（HOMA-β）、胰岛素稳态模型胰岛素抵抗指数（HOMA-IR）水平。结果  T2DM组血糖、胰高血糖素和游离脂肪酸分别为（8.70±0.73）mmol/L、（210.11±40.14）nmol/L和（0.89±0.21）mmol/L，与IGR组比较，差异有统计学意义（P <0.05），T2DM组高于IGR组；T2DM组胰岛素水平与对照组比较，差异有统计学意义（P <0.05）；IGR组胰岛素水平与对照组比较，差异有统计学意义（P <0.05）；T2DM组HOMA-IR为0.83（0.42，1.10），与IGR组、对照组比较，差异有统计学意义（P <0.05）；而HOMA-β为（3.61±0.72），与对照组比较，差异有统计学意义（P <0.05）；各组空腹胰高血糖素与HOMA-IR水平呈正相关（P <0.05），与HOMA-β呈负相关（P <0.05）；T2DM组和IGR组空腹胰高血糖素与游离脂肪酸呈正相关（P <0.05）；口服葡萄糖耐量试验30、60、90和120 min时T2DM组胰岛素水平与IGR组、对照组比较，差异有统计学意义（P <0.05），IGR组与对照组比较，差异有统计学意义（P <0.05）；口服葡萄糖耐量试验30、60、90和120 min时T2DM组胰高血糖素水平与IGR组、对照组比较，差异有统计学意义（P <0.05），IGR组与对照组比较，差异有统计学意义（P <0.05）。结论  T2DM和IGR患者胰岛α、β细胞分泌异常，其中胰高血糖素和游离脂肪酸水平升高，且与HOMA-IR和HOMA-β水平有相关性。

Functional changes of pancreatic islet α and β cells in patients with type 2 diabetes mellitus and impaired glucose regulation

 Abstract: Objective To investigate the changes of pancreatic islet α and β cell function in patients with type 2 diabetes mellitus (T2DM) and impaired glucose regulation (IGR). Methods From April 2014 to April 2016, 120 patients with T2DM and IGR were selected in our hospital including 68 patients with T2DM (T2DM group) and 52 patients with IGR (IGR group), 40 healthy persons were selected as control group. Insulin homeostasis model secretion index (HOMA-β) and insulin homeostasis model insulin resistance index (HOMA-IR) under fasting state were observed in each group. Results In the T2DM group, blood glucose, glucagon and free fatty acid were significantly higher than those the IGR group (P < 0.05). The insulin level in the T2DM group was significantly lower than that of the control group, and the insulin level in the IGR group was higher than that in the control group (P < 0.05). HOMA-IR in the T2DM group was significantly higher than that of the IGR group and the control group, and the HOMA-β in the T2DM group was significantly lower than that of the control group (P < 0.05). In each group fasting pancreatic glucagon was positively correlated HOMA-IR (P < 0.05), and negatively correlated with HOMA-β (P < 0.05). In the T2DM group and the IGR group fasting pancreatic glucagon and free fatty acids were positively correlated (P < 0.05). At 30, 60, 90 and 120 min of the OGTT experiment the insulin level in the T2DM group was lower than that in the IGR group and the control group, while the insulin level in the IGR group was lower than that in the control group (P < 0.05). At 30, 60, 90 and 120 min of OGTT experiment the glucagon level in the T2DM group was higher than that in the IGR group and the control group, while the glucagon level in the IGR group was higher than that in the control group (P < 0.05). Conclusions In the patients with IGR and T2DM, the secretion of islet α and β cells is abnormal wherein the glucagon and free fatty acid levels are significantly increased, the glucagon level is correlated with HOMA-IR and HOMA-β.