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目的探讨2型糖尿病患者的正常糖耐量亲属的胰岛α细胞及β细胞第一时相分泌功能的变化及其影响因素。方法选取有2型糖尿病家族史的糖耐量正常者40例为观察组(FH+组),无2型糖尿病家族史的健康志愿者55例为对照组(FH-组),分别采用氧化酶法测空腹血糖(FBG)及服糖后2h血糖(P2hBG),改良比色法测游离脂肪酸(FFA),化学发光法测胰岛素(INS),双抗体夹心ABC-ELISA法测胰高血糖素(GC),相应方法测定左旋精氨酸(L-ARG)刺激后2、4、6minINS与GC的变化,并计算稳态模型胰岛素抵抗评估指数(HOMA-IR)。结果①两组INS与GC均于2min达分泌峰值,4min开始下降;②与FH-组相比,FH+组P2hBG、FINS、HOMA-IR及FFA显著升高(P<0.05);INS峰倍数明显下降(P<0.05);但空腹GC和峰值倍数均无显著性变化(P>0.05);③相关结果分析显示:INS第一时相分泌峰倍数与P2hBG和FFA呈正相关(r分别为0.274,0.356,P均<0.05)。结论遗传背景下,2型糖尿病发生主要源于β细胞的功能下降。胰岛素峰倍数可能成为2型糖尿病发生、发展的重要预测因素。
Objective To investigate the changes of first phase secretory function of pancreatic α cells and β cells in normal glucose tolerance relatives of type 2 diabetic patients and its influencing factors. Methods Forty patients with family history of type 2 diabetes who had normal glucose tolerance were selected as observation group (FH + group), 55 healthy volunteers without family history of type 2 diabetes as control group (FH- group) Fasting blood glucose (FBG) and 2h blood sugar (P2hBG), colorimetric method of free fatty acid (FFA), chemiluminescence method of insulin (INS), double antibody sandwich ABC-ELISA method of glucagon (GC) The changes of INS and GC at 2, 4, 6min after L-arginine (L-arginine) stimulation were determined by the corresponding methods. The homeostasis model insulin resistance index (HOMA-IR) was calculated. Results ① Both INS and GC peaked at 2 min and decreased at 4 min. ② Compared with FH group, P2hBG, FINS, HOMA-IR and FFA were significantly increased (P <0.05) (P <0.05). However, there was no significant difference between the fasting GC and the peak fold (P> 0.05) .③The correlation analysis showed that the first peak of phase secretion was positively correlated with P2hBG and FFA (r = 0.274, 0.356, P <0.05). Conclusion In the genetic background, the occurrence of type 2 diabetes is mainly due to decreased function of β cells. The multiple of insulin peak may become an important predictor of the occurrence and development of type 2 diabetes.