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目的探讨2型糖尿病(T2DM)患者β细胞分泌功能及胰岛素抵抗指数(HOMA-IR)与糖尿病周围神经病变(DPN)的关系。方法选取合并DPN的T2DM患者96例,均行75g OGTT或标准餐试验,分别测定各时点血糖、C肽(C-P)水平。根据DPN程度分为轻、中、重3个组。采用胰岛β细胞功能指数(HOMA-β)评估胰岛细胞功能,HOMA-IR评估胰岛素抵抗(IR),比较组间各项相关指标的差异。结果轻度DPN与中度DPN比较,HOMA-IR在两组之间有统计学意义(P<0.01),HOMA-β无统计学意义(P>0.05)。轻度DPN与重度DPN比较,HOMA-IR,HOMA-β在两组之间均有统计学意义(P<0.01或P<0.05)。中度DPN与重度DPN比较,HOMA-IR,HOMA-β在两组之间亦有统计学意义(P<0.01或P<0.05),Pearson相关性分析结果显示,HOMA-IR与正中神经运动神经传导速度(MMCV)、尺总神经运动神经传导速度(UMCV)呈负相关(P<0.05)。结论DPN程度越重,其IR越重,胰岛素敏感性越差,早期测定DPN病变程度可在一定程度上反映胰岛功能情况。反之,早期可通过测定患者IR状况来评估其神经病变程度,对患者IR的早期干预,可延缓糖尿病神经病变的进展。
Objective To investigate the relationship between β-cell secretory function and insulin resistance index (HOMA-IR) and diabetic peripheral neuropathy (DPN) in type 2 diabetes mellitus (T2DM). Methods Totally 96 T2DM patients with DPN were involved in the study. The blood glucose and C-peptide levels were measured at 75 h OGTT or standard meal respectively. According to the degree of DPN is divided into light, medium and heavy 3 groups. Islet cell function index (HOMA-β) was used to assess islet cell function, HOMA-IR was used to assess insulin resistance (IR), and the differences between the groups were compared. Results Compared with moderate DPN, HOMA-IR had statistical significance (P <0.01) and HOMA-β had no statistical significance (P> 0.05). Compared with severe DPN, HOMA-IR and HOMA-βwere statistically significant between the two groups (P <0.01 or P <0.05). HOMA-IR and HOMA-β were also significantly different between the two groups (P <0.01 or P <0.05). Pearson correlation analysis showed that HOMA-IR and HOMA-β were positively correlated with the median motor nerve The conduction velocity (MMCV) and ulnar nerve conduction velocity (UMCV) were negatively correlated (P <0.05). Conclusion The more serious the DPN is, the heavier the IR is, and the worse the insulin sensitivity is. The extent of early DPN lesions can reflect the islet function to a certain extent. Conversely, the degree of neuropathy can be assessed early by measuring the patient’s IR status. Early intervention with patient IR delays the progression of diabetic neuropathy.