胰岛素1相分泌在类固醇性糖尿病与2型糖尿病鉴别诊断的价值研究

发布时间：2018-05-15 15:33

本文选题：类固醇性糖尿病 + 2型糖尿病　；参考：《广西医科大学》2016年硕士论文

【摘要】：目的：了解类固醇性糖尿病(steroid diabetes mellitus, SDM)患者胰岛功能情况,尤其是胰岛素1相分泌功能的变化情况,探讨胰岛素1相分泌在SDM与T2DM鉴别诊断中的价值,为临床提供更多诊断依据及指导治疗。方法：选取2011年1月至2016年3月在广西医科大学第一附属医院住院的皮质醇增多症患者60例(男性34例,女性26例),其中库欣综合征(Cushing's syndrome, CS)患者25例(男性3例,女性22例),医源性CS患者35例(其中男性31例,女性4例),同时收集69例为对照(男性48例,女性21例)。根据OGTT结果将皮质醇增多症组分为：①类固醇性糖尿病组(SDM)；②皮质醇增多症葡萄糖调节受损组(hypercortisolism IGR, HIGR)；③皮质醇增多症正常葡萄糖耐量组(hypercortisolism normal glucose tolerance, HNGT)。将对照组分为：①T2DM组；②IGR组；③NGT组。收集研究对象的临床资料,包括性别、年龄、病程、身高、体重、收缩压(Systolic blood pressure, SBP)、舒张压(Diastolic blood pressure, DBP)、血脂、肝功、糖化血红蛋白(Glycosylated hemoglobin, HbAlc),同时行OGTT、IVGTT。IVGTT急性时相胰岛素分泌(The acute phase of insulin secretion, AIR0-10min)、胰岛素曲线下面积(Area under the curve of insulin, AUCins0-10min)评估胰岛素1相分泌功能；使用OGTT胰岛素抵抗指数(Homeostasis model assessment of insulin resistance, HOMA-IR)评估胰岛素抵抗状态；OGTT胰岛素曲线下面积(AUCins0.3h)、胰岛素曲线下面积／血糖曲线下面积(Area under the curve of glucose, AUCglu)(AUCins/AUCgluo-3h)评估胰岛素2相分泌功能,同时联合OGTT修正的胰岛p细胞功能指数(Modified beta cell function index, MBCI)、胰岛素分泌功能指数(Homeostasis model assessment of insulin secretion, HOMA-p)以及OGTT、IVGTT的峰值胰岛素(Peak insulin, Ip)／基础胰岛素(Fasting insulin, Io) (Ip/Io)指标来评估胰岛p细胞分泌功能状态。探讨SDM与T2DM胰岛功能有无差别,尤其是胰岛素1相分泌功能。结果：1、皮质醇增多症患者中,DM、IGR、NGT比例分别为43.3%、33.3%、23.3%；SDM中单纯空腹血糖升高、单纯餐后血糖升高及空腹和餐后均升高比例分别为7.7%、69.2%、23.1%；存在高血压患者达65.0%,SDM发病年龄早于T2DM, SDM患者TC、HDL及血压均高于T2DM;2、OGTT中,皮质醇增多症组HOMA-IR、HOMA-β均较相应的对照组高,但二者间比较差异均无统计学意义(P均0.05)；皮质醇增多症组中的IGR、DM组的AUCins0-3h、AUCins/AUCgluo-3h分别高于相应对照IGR, DM组,差异有统计学意义(P0.05); SDM组的Ip高于T2DM组(P0.05)；在对照组中,NGT组的MBCI高于IGR、DM组,(P0.05)。3、IVGTT中,除T2DM组胰岛分泌呈低平曲线、无明显分泌高峰外,余各组胰岛素峰值大部分出现在2～4min, SDM组的Ip、Ip/I0、AIR0-10min、AUCins0-10min均高于T2DM,差异有统计学意义(P0.05)。结论：1、皮质醇增多症患者中,类固醇性糖尿病发病率高,发病年龄相对T2DM早,且以餐后血糖升高为主,多数伴有血压升高。2、类固醇性糖尿病患者胰岛分泌功能优于2型糖尿病,其1相分泌功能仍存在,尤其是IVGTT检测中的Ip/I0可作为类固醇性糖尿病与2型糖尿病鉴别诊断的指标。
[Abstract]:Objective: to understand the islet function of patients with steroid diabetes mellitus (SDM), especially the changes in the 1 phase secreting function of insulin, and to explore the value of insulin 1 phase secretion in the differential diagnosis of SDM and T2DM, to provide more diagnostic basis and guidance for clinical treatment. Methods: from January 2011 to March 2016. 60 cases of polycythemia in the First Affiliated Hospital of Guangxi Medical University (34 males and 26 females) were found in the First Affiliated Hospital of Guangxi Medical University, including 25 cases of Cushing syndrome (Cushing's syndrome, CS) and 35 cases of iatrogenic CS (including 31 males and 4 women), and 69 cases (male 48, female 21). According to OGTT knot The corticosteroid group was divided into three groups: (1) steroid diabetic group (SDM); (2) the impaired glucose regulation group (hypercortisolism IGR, HIGR) of cortisol; (3) the normal glucose tolerance group (hypercortisolism normal glucose tolerance, HNGT). (1) the control group was divided into: (1) T2DM group; (2) IGR group; (3) NGT group. The clinical data of the subjects were collected, including sex, age, course of disease, height, weight, Systolic blood pressure (SBP), diastolic pressure (Diastolic blood pressure, DBP), blood lipid, liver function, glycosylated hemoglobin (Glycosylated hemoglobin, HbAlc). N secretion, AIR0-10min), the area under the insulin curve (Area under the curve of insulin, AUCins0-10min) assessed the 1 phase secreting function of insulin; the islet resistance state was evaluated using the OGTT insulin resistance index. The area under the islet curve (Area under the curve of glucose, AUCglu) (AUCins/AUCgluo-3h) assessed the 2 secretory function of insulin, and combined the OGTT modified islet P cell function index (Modified beta) and the islet secretory function index. Cretion, HOMA-p) and OGTT, IVGTT (Peak insulin, Ip) / basal insulin (Fasting insulin, Io) (Ip/Io) index to evaluate the secretory function of islet P cells. For 43.3%, 33.3%, 23.3%, the increase in simple fasting blood glucose in SDM was 7.7%, 69.2%, 23.1%, respectively, and 65% in patients with hypertension, the age of SDM was earlier than that of T2DM, TC, HDL, and blood pressure in SDM patients were higher than T2DM; 2, OGTT, and cortisol group HOMA-IR and HOMA- beta were corresponding to the corresponding pairs. There was no statistically significant difference between the two groups (P 0.05), and IGR in the cortisol group, AUCins0-3h in group DM and AUCins/AUCgluo-3h in group DM, respectively, with statistical significance (P0.05), and Ip in the SDM group was higher than that in the T2DM group (P0.05). In addition to the low level secretion of islet secretion in group T2DM and no obvious secretory peak, most of the peaks of insulin in the remaining groups were 2 to 4min, Ip, Ip/I0, AIR0-10min, AUCins0-10min in group SDM were higher than T2DM, and the difference was statistically significant (P0.05). Conclusion: 1, the incidence of steroid diabetes is high in patients with cortisol, and the age of onset is relatively T. 2DM early, mainly with elevated postprandial blood glucose, mostly accompanied by elevated blood pressure of.2, the islet secretory function of steroid diabetic patients is superior to type 2 diabetes, and its 1 phase secretory function still exists, especially the Ip/I0 in IVGTT detection can be used as an indicator of the differential diagnosis of steroid diabetes and type 2 diabetes.

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

【相似文献】