2型糖尿病肥胖与胰岛功能、GLP-1及GC水平的相关性研究

发布时间：2018-04-21 04:42

本文选题：肥胖 + 2型糖尿病　；参考：《河北医科大学》2016年硕士论文

【摘要】：目的:观察不同BMI及不同腰围(WC)的2型糖尿病患者胰岛功能及血清GLP-1和GC水平,探讨肥胖与2型糖尿病患者的胰岛功能、GLP-1和GC水平的相关性。方法:选取2015年3月~2015年11月,于河北医科大学第三医院就诊的2型糖尿病患者85例,依据BMI将研究对象分为正常BMI组、超重组和肥胖组;依据WC分为腹型肥胖(Abdominal obesity,AO)组和非腹型肥胖(Non-abdominal obesity,NAO)组。所有受试者均于禁食8~12小时后行口服75g葡萄糖耐量试验(oral glucose tolerance test,OGTT),分别采集0、30min、120min时的肘静脉血,检测各时间点血样的血糖(BG)、胰岛素(INS)、C肽(CP)、胰高血糖素样肽-1(GLP-1)和胰高血糖素(GC)水平,并计算胰岛素敏感指数(ISI)、稳态模型胰岛素抵抗指数(HOMA-IR)、稳态模型胰岛β细胞功能指数(HOMA-β)、早相胰岛素分泌指数(△I30/△G30)和晚相胰岛素分泌指数(AUC_(ins)/AUCg)。结果:不同BMI组比较:超重组和肥胖组的AUC_(ins)、AUC_(cp)、△I30/△G30、AUC_(ins)/AUCg及HOMA-IR显著高于正常BMI组(P0.05),ISI显著低于正常BMI组(P0.05)(见表3、5、7),两两比较结果显示超重组和肥胖组无明显差异(P0.05)。各组组内三个时间点INS、CP水平依次升高,差异有统计学意义(P0.001)(见图1、2);GLP-1水平于服糖后30min达峰,2h回到基础水平,组内各时间点差异有统计学意义(P0.05)。超重组、肥胖组三个时间点GC水平随INS、CP水平的增加较空腹水平出现上升趋势,但差异未达到统计学意义(P0.05);不同WC组比较:AO组AUC_(ins)、AUC_(cp)、HOMA-IR显著高于NAO组,ISI显著低于NAO组(P均0.05)(见表4、6、8)。各组组内三个时间点INS、CP水平依次升高,差异有统计学意义(P0.001)(见图5、6);GLP-1水平于服糖后30min达峰,2h回到基础水平,组内各时间点差异有统计学意义(P0.05)。AO组三个时间点GC水平随INS、CP水平的增加较空腹水平出现上升趋势,但差异均未达到统计学意义(P0.05);相关分析显示,BMI与SBP、DBP、TG、FINS、FCP、AUC_(ins)、AUC_(cp)、AUC_(ins)/AUCg及HOMA-IR呈正相关(相关系数分别为0.386、0.274、0.35、0.214、0.336、0.222、0.234、0.288,P均0.05),与HDL-C、ISI呈显著负相关(r=-0.243,-0.288,P0.05,0.01);WC与SBP、DBP、TG、FCP、AUCCP、HOMA-IR存在正相关(r=0.299、0.352、0.284、0.401、0.262、0.238,P0.05),与HDL-C、ISI存在负相关(r=-0.252、-0.234,P0.05);WHR与SBP、DBP、TG、FCP存在正相关(r=0.328、0.401、0.228、0.257,P0.05),与其他变量无相关性(P0.05)。进一步将BMI、WC及WHR与相关变量做逐步回归分析,得到回归方程:(1)Y_(BMI)=6.131+0.04X_(SBP)+0.146X_(DBP)+1.191 X_(FCP),R~2=34.5%;(2)Y_(WC)=56.57+3.423X_(FCP)+0.322 X_(DBP),R~2=22.8%;(3)Y_(WHR)=0.747+0.002 X_(DBP),R~2=14.9%.P均=0.000,以上三个方程均有统计学意义。结论:1随着BMI和WC的增加(尤其是BMI增加),T2DM患者的胰岛素分泌能力代偿性增加,提示肥胖T2DM患者存在更明显的胰岛素抵抗,且BMI较WC与胰岛素抵抗和胰岛素敏感性关系更密切。2肥胖T2DM患者服糖后各时间点的GC水平随INS、CP水平的增加有增加趋势,说明INS抑制GC分泌的作用减弱,提示胰岛α细胞可能存在胰岛素抵抗。3超重和肥胖T2DM患者的基础和葡萄糖刺激后GLP-1水平有降低趋势。
[Abstract]:Objective: To observe the islet function and serum GLP-1 and GC levels of type 2 diabetic patients with different BMI and different waist circumference (WC), and to explore the correlation between the islet function and the level of GLP-1 and GC in patients with type 2 diabetes. Methods: 85 patients with type 2 diabetes in the Third Hospital of Hebei Medical University in March 2015 were selected according to BMI. The subjects were divided into the normal BMI group, the super recombinant and the obese group. According to the WC, the subjects were divided into abdominal obesity (Abdominal obesity, AO) and non abdominal obesity (Non-abdominal obesity, NAO). All subjects were given the oral 75g glucose tolerance test (oral glucose) after fasting 8~12 hours. Blood blood, blood glucose (BG), insulin (INS), C peptide (CP), glucagon like peptide -1 (GLP-1) and glucagon (GC), insulin sensitivity index (ISI), homeostasis model insulin resistance index (HOMA-IR), stable model islet beta cell function index (HOMA- beta), and early phase insulin secretion index (delta I30/ Delta G30). And late phase insulin secretion index (AUC_ (INS) /AUCg). Results: compared with group BMI, AUC_ (INS), AUC_ (CP), AUC_ (CP), Delta I30/ Delta G30, AUC_ (INS) were significantly higher than those in the normal group (see table). The results showed that there was no significant difference between the group and the obese group. 5) at three time points INS, CP level increased in turn, the difference was statistically significant (P0.001) (see Figure 1,2), GLP-1 level was 30min peak at the level of sugar, 2h returned to the base level, and the difference in time points in the group was statistically significant (P0.05). The level of GC in the three time points of the obese group increased with INS, CP level increased compared with the fasting level. Trend, but the difference was not statistically significant (P0.05), and in group WC, AUC_ (INS), AUC_ (CP), HOMA-IR were significantly higher than group NAO (CP), ISI was significantly lower than NAO group (P mean 0.05). To the basic level, the difference in time points within the group was statistically significant (P0.05) at the three time points of group.AO, the level of GC increased with the level of INS, and the level of CP increased more than that of the fasting level, but the difference was not statistically significant (P0.05). The correlation coefficient is 0.386,0.274,0.35,0.214,0.336,0.222,0.234,0.288, P is 0.05), and it is negatively correlated with HDL-C, ISI (r=-0.243, -0.288, P0.05,0.01). WC and SBP, DBP, TG, FCP. There is a positive correlation (r=0.328,0.401,0.228,0.257, P0.05) and no correlation with other variables (P0.05). Further regression analysis of BMI, WC and WHR and related variables is made to get the regression equation: (1) Y_ (BMI) =6.131+0.04X_ (SBP) +0.146X_ (2); (3) 747+0.002 X_ (DBP), R~2=14.9%.P =0.000, all of the above three equations were statistically significant. Conclusion: 1 with the increase of BMI and WC (especially BMI increase), the insulin secretion ability of T2DM patients is compensatory, suggesting that obese T2DM patients have more obvious insulin resistance, and BMI is more closely related to insulin resistance and insulin sensitivity. The level of GC in each time point of.2 obese T2DM patients increased with the increase of INS and CP levels, indicating that the effect of INS to inhibit the secretion of GC decreased, suggesting that islet alpha cells may have the basis of insulin resistance to.3 overweight and obese T2DM patients and the decreasing trend of GLP-1 level after glucose stimulation.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R587.1

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