探讨2型糖尿病酮症和非酮症患者胰岛β细胞功能的差异
发布时间：2019-04-27 20:14
【摘要】：目的:比较2型糖尿病酮症患者和非酮症患者胰岛β细胞功能的差异。方法:选取2012年6月至2016年12月在广西医科大学第一附属医院住院治疗的2型糖尿病患者作为研究对象。以上2型糖尿病患者均符合1999年WHO糖尿病的诊断标准诊断,患者无代谢性酸中毒、高渗状态、饥饿、感染、手术、外伤等情况,并除外1型糖尿病、妊娠糖尿病及其它特殊类型糖尿病。符合上述标准的2型糖尿病患者共132例,根据尿酮或血酮体是否阳性分为非酮症组与酮症组,其中,非酮症组62例,酮症组70例。上述患者均测量并记录一般情况如性别、年龄、身高、体重,次日清晨采血测糖化血清蛋白、糖化血红蛋白、总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇,住院期间予胰岛素、药物降糖治疗,以4.4FPG7.0mmol/L,2hPG10.0mmol/L为目标,患者尿酮或血酮体转阴后行口服葡萄糖耐量试验、C肽释放试验,计算HOMA-IR、HOMA-β,计算血糖曲线下面积、C肽曲线下面积。结果:1.酮症组的糖化血红蛋白、糖化血清蛋白较非酮症组高,差别有统计学意义(P0.01)。2.酮症组的总胆固醇、甘油三酯水平较非酮症组高,差别有统计学意义(P0.05);两组间的高密度脂蛋白胆固醇、低密度脂蛋白胆固醇差别无统计学意义(P0.05)。3.两组间的空腹血葡萄糖、口服葡萄糖耐量试验30min血葡萄糖差别无统计学差异(P0.05);酮症组的口服葡萄糖耐量试验60min、120min、180min血葡萄糖测定高于非酮症组,差别有统计学意义(P0.05)。酮症组的PG-AUC值大于非酮症组,差别有统计学意义(P0.05)。4.非酮症组的空腹C肽、30minC肽、60minC肽、120minC肽均高于酮症组,差别具有统计学意义(P0.01);两者的180minC肽差异无统计学意义(P0.05)。非酮症组的CP-AUC值大于酮症组,差别有统计学意义(P0.05)非酮症组的C肽释放高峰在120min,酮症组的C肽释放高峰在180min甚至更往后的时间。5.酮症组的HOMA-IR值大于非酮症组,差别有统计学意义(P0.05),即酮症组的胰岛素抵抗更加明显;非酮症组HOMA-β大于酮症组,差别具有统计学意义(P0.01),即酮症组的胰岛素分泌功能更弱。结论:2型糖尿病酮症患者的胰岛β细胞功能较非酮症患者差;2型糖尿病酮症患者的糖毒性、脂毒性较非酮症患者明显。
[Abstract]:Objective: to compare the 尾-cell function between type 2 diabetic ketosis and non-ketosis. Methods: type 2 diabetic patients admitted to the first affiliated Hospital of Guangxi Medical University from June 2012 to December 2016 were selected as subjects. The above-mentioned patients with type 2 diabetes meet the diagnostic criteria of WHO diabetes mellitus in 1999. The patients have no metabolic acidosis, hypertonic state, hunger, infection, surgery, trauma, etc., with the exception of type 1 diabetes mellitus. Gestational diabetes mellitus and other special types of diabetes. 132 patients with type 2 diabetes were divided into non-ketosis group and ketosis group according to whether urine ketones or blood ketones were positive, including 62 cases of non-ketosis group and 70 cases of ketosis group. These patients were measured and recorded in general terms such as sex, age, height, weight, blood samples for glycosylated serum protein, glycosylated hemoglobin, total cholesterol, triglycerides, and high density lipoprotein cholesterol the next morning. Low-density lipoprotein cholesterol (LDL-C) was treated with insulin during hospitalization, taking 4.4 FPG 7.0 mmol / L, 2h PG10.0mmol / L as the target. Oral glucose tolerance test and C-peptide release test were performed after conversion of urinary ketones or blood ketones. HOMA-IR,HOMA- 尾 was calculated, area under blood glucose curve and area under C peptide curve were calculated. Results: 1. The glycosylated hemoglobin and glycosylated serum protein in ketosis group were higher than those in non-ketosis group (P0.01). The levels of total cholesterol and triglyceride in ketosis group were higher than those in non-ketosis group (P0.05), but there was no significant difference in HDL-C and LDL-C between the two groups (P0.05). There was no significant difference between the two groups in fasting blood glucose and oral glucose tolerance test (30min) (P0.05). The oral glucose tolerance test in ketosis group was higher than that in non-ketosis group at 60 min, 120 min, 180 min, and the difference was statistically significant (P0.05). The PG-AUC of ketosis group was higher than that of non-ketosis group, the difference was statistically significant (P0.05). The fasting C peptide, 30 min C peptide, 60 min C peptide, 120 min C peptide in non-ketosis group were significantly higher than those in ketosis group (P0.01), but there was no significant difference in 180minC peptide between the two groups (P0.05). The CP-AUC value of the non-ketosis group was higher than that of the ketosis group, the difference was statistically significant (P0.05) the peak of C-peptide release in the non-ketosis group was at 120 min, and the C-peptide release peak in the ketosis group was even longer than that in the ketosis group. 5. The HOMA-IR value of ketosis group was higher than that of non-ketosis group, the difference was statistically significant (P0.05), that is, the insulin resistance of ketosis group was more obvious than that of non-ketosis group. The HOMA- 尾 in the non-ketosis group was higher than that in the ketosis group, and the difference was statistically significant (P0.01), that is, the insulin secretion function in the ketosis group was weaker than that in the ketosis group. Conclusion: the 尾-cell function of type 2 diabetic ketosis patients is worse than that of non-ketotic patients, and the glucotoxicity and lipotoxicity of type 2 diabetic ketosis patients is more obvious than that of non-ketotic patients.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.2
本文编号：2467275
[Abstract]:Objective: to compare the 尾-cell function between type 2 diabetic ketosis and non-ketosis. Methods: type 2 diabetic patients admitted to the first affiliated Hospital of Guangxi Medical University from June 2012 to December 2016 were selected as subjects. The above-mentioned patients with type 2 diabetes meet the diagnostic criteria of WHO diabetes mellitus in 1999. The patients have no metabolic acidosis, hypertonic state, hunger, infection, surgery, trauma, etc., with the exception of type 1 diabetes mellitus. Gestational diabetes mellitus and other special types of diabetes. 132 patients with type 2 diabetes were divided into non-ketosis group and ketosis group according to whether urine ketones or blood ketones were positive, including 62 cases of non-ketosis group and 70 cases of ketosis group. These patients were measured and recorded in general terms such as sex, age, height, weight, blood samples for glycosylated serum protein, glycosylated hemoglobin, total cholesterol, triglycerides, and high density lipoprotein cholesterol the next morning. Low-density lipoprotein cholesterol (LDL-C) was treated with insulin during hospitalization, taking 4.4 FPG 7.0 mmol / L, 2h PG10.0mmol / L as the target. Oral glucose tolerance test and C-peptide release test were performed after conversion of urinary ketones or blood ketones. HOMA-IR,HOMA- 尾 was calculated, area under blood glucose curve and area under C peptide curve were calculated. Results: 1. The glycosylated hemoglobin and glycosylated serum protein in ketosis group were higher than those in non-ketosis group (P0.01). The levels of total cholesterol and triglyceride in ketosis group were higher than those in non-ketosis group (P0.05), but there was no significant difference in HDL-C and LDL-C between the two groups (P0.05). There was no significant difference between the two groups in fasting blood glucose and oral glucose tolerance test (30min) (P0.05). The oral glucose tolerance test in ketosis group was higher than that in non-ketosis group at 60 min, 120 min, 180 min, and the difference was statistically significant (P0.05). The PG-AUC of ketosis group was higher than that of non-ketosis group, the difference was statistically significant (P0.05). The fasting C peptide, 30 min C peptide, 60 min C peptide, 120 min C peptide in non-ketosis group were significantly higher than those in ketosis group (P0.01), but there was no significant difference in 180minC peptide between the two groups (P0.05). The CP-AUC value of the non-ketosis group was higher than that of the ketosis group, the difference was statistically significant (P0.05) the peak of C-peptide release in the non-ketosis group was at 120 min, and the C-peptide release peak in the ketosis group was even longer than that in the ketosis group. 5. The HOMA-IR value of ketosis group was higher than that of non-ketosis group, the difference was statistically significant (P0.05), that is, the insulin resistance of ketosis group was more obvious than that of non-ketosis group. The HOMA- 尾 in the non-ketosis group was higher than that in the ketosis group, and the difference was statistically significant (P0.01), that is, the insulin secretion function in the ketosis group was weaker than that in the ketosis group. Conclusion: the 尾-cell function of type 2 diabetic ketosis patients is worse than that of non-ketotic patients, and the glucotoxicity and lipotoxicity of type 2 diabetic ketosis patients is more obvious than that of non-ketotic patients.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.2
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相关期刊论文 前3条
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