胰高血糖素在初发2型糖尿病中的作用研究

发布时间：2018-06-07 03:03

本文选题：2型糖尿病 + 胰岛素　；参考：《苏州大学》2015年硕士论文

【摘要】：目的:观察初发2型糖尿病患者西格列汀治疗后胰高血糖素(glucagon)及胰岛素(insulin)的动态变化;探讨胰高血糖素在初发2型糖尿病患者发病过程中的作用机制。方法:2型糖尿病组50例,在我院门诊及住院就诊的初发2型糖尿病患者,其HbA1c≤10%,FBG≥7.0mmol/L,2hPG≥11.1mmol/L,最高血糖≤20.0mmol/L,依据WHO(1999年)推荐的糖尿病诊断标准。上诉患者均未使用影响胰岛素敏感性及糖代谢的药物(如糖皮质激素、利尿剂及β受体阻断剂等),无应激及胃肠疾病和胃肠手术史。健康对照组48例,均无任何内分泌及代谢病史。所有受试者空腹12小时,次日清晨空腹测量身高、体重、血压,抽取空腹静脉血,测血清总胆固醇、甘油三酯、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇水平。健康对照组和糖尿病组分别于5 min内服完溶于350 mL纯水中的75 g葡萄糖粉。于空腹及糖负荷后30min、60min、120min、180min分别抽取静脉血,同步测血糖、胰高血糖素和胰岛素水平。糖尿病组予磷酸西格列汀100mg口服,每日一次。3个月后行糖负荷试验,于空腹及服糖后30min、60min、120min、180min抽取静脉血同步测血糖、胰高血糖素和胰岛素水平。数据以均数±标准差(x±s)表示,组间比较采用t检验,采用SPSS 13.0统计软件进行处理,p0.05为差异有统计学意义。数据请仔细校对,我仅指出一处,其他你自己看看,包括正文中的结果:(1)糖尿病组的空腹及餐后各时相的血糖水平都较健康对照组升高[0h:(9.5?0.9)mmol/l vs(5.1?0.3)mmol/l,30min:(10.1?0.9)mmol/l vs(6.3?0.3)mmol/l,60min:(15.3?1.3)mmol/l vs(7.8?0.3)mmol/l,120min:(12.3?1.0)mmol/l vs(5.9?0.2)mmol/l,180min:(8.7?0.7)mmol/l vs(4.7?0.1)mmol/l](P0.05);糖尿病组各时相胰高血糖素水平显著高于健康对照组[0h:(149.2?7.8)ng/l vs(132.3?4.3)ng/l,30min:(188.1?8.5)ng/l vs(112.7?3.6)ng/l,60min:(204.6?10.3)ng/l vs(105.8?3.4)ng/l,120min:(158.2?9.2)ng/l vs(121.5?3.8)ng/l,180min:(142.1?9.0)ng/l vs(127.4?3.9)ng/l](P0.05)],且糖尿病组服用葡萄糖后胰高血糖素水平明显升高,60min显著高于其空腹水平(P0.05),180min基本恢复到空腹水平。正常人组服用葡萄糖后60min略有下降,后各时相逐渐上升,180min稍低于空腹水平,各时相变化差异均无显著性(P0.05);糖尿病病人服用葡萄糖后胰岛素水平较正常人相比出现明显高峰延迟,且30min及60min时相明显低于正常人[30min:(12.5?1.1)mU/l vs(53.3?3.5)mU/l,60min:(27.5?3.8)mU/l vs(68.2?3.8)mU/l](P0.05、0.01)]。糖尿病病人服用葡萄糖后胰岛素水平上升缓慢,餐后60 min和120 min显著高于其空腹水平(P0.05),180 min时基本恢复到30 min水平;正常人餐后胰岛素水平快速上升,60min达到高峰(P0.01),180min时基本恢复到空腹水平。(2)西格列汀治疗三个月后患者血糖水平明显低于治疗前[0h:(7.3?0.8)mmol/l vs(9.5?0.9)mmol/l,30min(9.2?1.1)mmol/l vs(10.1?0.9)mmol/l,60min:(12.2?1.2)mmol/l vs(15.3?1.3)mmol/l,120min:(10.7?0.9)mmol/l vs(12.3?1.0)mmol/l,180min:(7.1?0.7)mmol/l vs(8.7?0.7)mmol/l,](P0.05);治疗后各时相胰高血糖素水平低于治疗前水平[0h:(141.8?6.6)ng/l vs(149.2?7.8)ng/l,30min:(162.7?6.9)ng/l vs(188.1?8.5)ng/l,60min:(182.4?7.8)ng/l vs(204.6?10.3)ng/l,120min:(147.9?7.0)ng/l vs(158.2?9.2)ng/l,180min:(133.5?7.3)ng/l vs(142.1?9.0)ng/l](P0.05);治疗后胰岛素水平高于治疗前水平[0h:(8.9?1.0)mU/l vs(8.2?0.9)mU/l,30min:(17.5?1.2)mU/l vs(12.5?1.1)mU/l,60min:(33.8?1.2)mU/l vs(27.5?3.8)mU/l,120min:(48.5?1.5)mU/l vs(32.9?2.7)mU/l,180min:(16.7?1.9)mU/l vs(14.5?1.4)mU/l]。结论:1.初发2型糖尿病患者较健康对照组有更高的胰高血糖素水平,胰岛素其各时相水平明显低于健康对照组,且高峰延迟,提示β细胞、α细胞功能异常导致胰岛素、胰高血糖素的失衡是2型糖尿病患者高血糖发生、发展的重要病理生理基础。2.西格列汀治疗三个月后在控制血糖的同时显著改善胰岛素、胰高血糖素分泌的失衡,改善了胰岛α、β细胞功能,具有重要的临床应用价值。
[Abstract]:Objective: To observe the dynamic changes of glucagon (glucagon) and insulin (insulin) after Sig Leo Dean treatment in patients with primary type 2 diabetes, and to explore the mechanism of glucagon in the onset of type 2 diabetes. Method: 50 cases of type 2 diabetes mellitus in the outpatient and hospitalized patients with type 2 diabetes in our hospital, the HbA1c < 10%, FBG > 7.0mmol/L, 2hPG > 11.1mmol/L, the highest blood sugar is less than 20.0mmol/L. According to the diabetes diagnostic criteria recommended by WHO (1999), the appellate patients have not used drugs that affect insulin sensitivity and glucose metabolism (such as glucocorticoids, diuretics and beta blockers), without stress and the history of gastrointestinal diseases and gastrointestinal surgery. Healthy control group 48 All subjects had no history of endocrine and metabolic disease. All the subjects were empty stomach for 12 hours. The following morning, the height, weight, blood pressure, fasting venous blood were measured on the fasting morning. The serum total cholesterol, triglycerides, low density lipoprotein cholesterol and high density lipoprotein cholesterol levels were measured. The healthy control group and the diabetic group were dissolved in 350 m in 5 min, respectively. L 75 g grape sugar powder in pure water. Venous blood was extracted from 30min, 60min, 120min, 180min after empty stomach and sugar load respectively. Blood glucose, glucagon and insulin level were measured synchronously. The diabetic group was given oral ciceretine phosphate 100mg. After one month.3 months, the sugar load test was performed. The venous blood was extracted from the fasting and after taking sugar 30min, 60min, 120min, 180min. Synchronously measured blood sugar, glucagon and insulin level. The data were expressed with mean standard deviation (x + s), t test was used and SPSS 13 statistical software was used. The difference was statistically significant. Please proofread the data carefully. I only pointed out one place, and other you, including the results in the text: (1) the diabetes group was empty. [0h: (9.5? 0.9) mmol/l vs (5.1? 0.3) mmol/l, 30min: (10.1? 0.9) mmol/l vs (6.3? 0.3) mmol/l, 60min: (15.3? 1.3) mmol/l vs (7.8? 0.3) Hyperglycemic level was significantly higher than that of [0h: (149.2? 7.8) ng/l vs (132.3? 4.3) ng/l, 30min: (188.1? 8.5) ng/l vs (112.7? 3.6) ng/l, 60min: (204.6? 10.3) ng/l vs (105.8? 3.4) ng/l, and diabetes group after taking glucose The level of glucosin was significantly higher, 60min was significantly higher than the fasting level (P0.05), and 180min was basically restored to the fasting level. The 60min decreased slightly in the normal group after taking glucose, and the phase phase gradually increased, and the 180min was slightly lower than the fasting level. The difference of each phase was not significant (P0.05); the insulin level of diabetic patients after taking glucose was more positive. 30min and 60min were significantly lower than those of normal people, and 30min and 60min were significantly lower than normal people [30min: (12.5? 1.1) mU/l vs (53.3? 3.5) mU/l, 60min: (27.5? 3.8) mU/l vs (68.2? 3.8) mU/l] (P0.05,0.01)]. The insulin levels of diabetic patients increased slowly, 60 and 120 after meals were significantly higher than their fasting levels, 180. The basic recovery was to 30 min level, the normal level of insulin after meal increased rapidly, 60min reached its peak (P0.01), and 180min was basically restored to the fasting level. (2) the blood glucose level of patients after three months of Sig Leo Dean treatment was significantly lower than [0h: (7.3? 0.8) mmol/l vs (9.5? 0.9) mmol/l before treatment, 30min (9.2? 1.1) mmol/l vs (10.1? 0.9) mmol/l, 12.2? 1.2) Mmol/l vs (15.3? 1.3) mmol/l, 120min: (10.7? 0.9) mmol/l vs (12.3? 1) mmol/l, 180min: (7.1? 0.7) mmol/l vs (8.7? 0.7) mmol/l,] (P0.05); after treatment, the level of glucagon is lower than before treatment (141.8? 6.6) 20min: (147.9? 7) ng/l vs (158.2? 9.2) ng/l, 180min: (133.5? 7.3) ng/l vs (142.1? 9) ng/l] (P0.05); after treatment, insulin levels are higher than before the treatment level [0h: (8.9? 1) mU/l vs (8.2? 0.9). MU/l vs (14.5? 1.4) mU/l]. conclusion: 1. patients with type 2 diabetes have higher glucagon levels than those in the healthy control group. The levels of insulin are significantly lower than those in the healthy control group, and the peak delay is delayed, suggesting that the abnormal function of the beta cells, the abnormal function of the alpha cells, is the occurrence of hyperglycemia in type 2 diabetic patients. The important pathophysiological basis,.2. ciceretine, can improve insulin and glucagon secretion and improve the function of pancreatic islet alpha and beta cells after three months of control of blood glucose, which has important clinical value.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R587.1

【参考文献】