摘要
目的探讨2型糖尿病患者的胰岛β细胞分泌功能及胰岛素敏感性与内生肌酐清除率（creatinine clearancerate，Ccr，ml·min^-1·1．73^-1m^-2）的相关性。方法432例2型糖尿病患者按Ccr水平分为4组：。肾功能正常组（90≤Ccr〈130，123例）、肾小球高滤过组（Ccr≥130，80例）、肾功能轻度下降组（60≤Ccr〈90，145例）和肾功能中重度下降组（Ccr〈60，84例）。进行口服葡萄糖耐量试验及胰岛素释放试验，用稳态模型评估的胰岛素抵抗指数（HOMA—IR）、胰岛素曲线下面积（AUC1）和葡萄糖曲线下面积（AUCG）的比值（AUC1／AUCG）来评价胰岛素抵抗；用胰岛素敏感指数（ISI）及Matsuda ISI来反映胰岛素敏感性；以稳态模型评估的β细胞功能指数（HOMA—β）、早期胰岛素分泌功能指数（△130／△G30）、第二时相胰岛素分泌功能指数（胰岛素曲线下面积）及葡萄糖处置指数（disposal index，DI）评价胰岛β细胞分泌功能；比较各组间各指标的差异，并对Ccr与胰岛素抵抗相关指标进行相关性分析。结果（1）与肾功能正常组相比，肾功能轻度下降、肾功能中重度下降组HOMA—IR明显升高，ISI、Matsuda ISI明显下降（P〈0．01）；肾功能中重度下降组AUC1／AUCG明显高于其他3组（P〈0．05）。（2）肾功能中重度下降组AUC1明显高于其他3组（P〈0．05）；肾功能轻度下降、肾功能中重度下降组DI明显低于肾功能正常组（P〈0．05）。（3）Ccr与糖尿病病程、收缩压、舒张压、AUC1、HOMA—IR、AUC1／AUCG呈负相关（P〈0．05），与ISI、Matsuda ISI呈正相关（P〈0．01）；多元逐步回归分析结果显示Ccr与收缩压、病程、AUC1／AUCG呈负相关（P〈0．05）。结论在2型糖尿病中，Ccr与胰岛素抵抗负相关，随着Ccr的下降，胰岛素抵抗逐渐加重，胰岛素抵抗可能是肾功能下降的独立危险因素。
Objective To investigate the relevance between islet β-cell insulin secretion, insulin sensitivity and endogenous creatinine clearance rate （ Ccr, ml·min^-1·1.73^-1m^-2 ） in type 2 diabetic patients. Methods Four-hundred and thirty-two cases of type 2 diabetic patients were enrolled,including 123 cases with normal renal function （ 90 ≤ Ccr 〈 130 ）, 80 cases with glomerular hyperfihration （ Ccr ≥ 130 ）, 145 cases with mild renal dysfunction（60 ≤ Ccr〈90）and 84 cases with moderate and severe renal dysfunction （Ccr〈60）. Oral glucose tolerance and insulin releasing test were performed. The insulin resistance was evaluated by the ratio of area under curve of insulin to area under curve of glucose （ AUCI/AUCG ） and homeostasis model assessment for insulin resistance（ HOMA-IR）. The insulin sensitivity was reflected by insulin sensitivity index（ISI） and Matsuda ISI. The homeostasis model assessment for β-cell function （ HOMA-β ） , early insulin secretion index （ △130/△G30 ） , the second-phase insulin secretion index （AUC1）and disposal index （DI）were calculated to estimate islet β-cell secretary function. The differences between clinical and biochemical parameters were compared among the four groups,and the correlation between Ccr and IR was analyzed. Results （ 1 ） Compared with the normal renal function group, the HOMA-IR in the groups with mild, moderate and severe renal dysfunction was significantly higher（ P〈0.01 ） ,while the ISI and Matsuda ISI were significantly lower（ P〈0.01 ）. The AUC1/AUCG in the groups with moderate and severe renal dysfunction was higher than that in the other three groups（ P〈0.05 ）. （2）The AUC1 in the groups with moderate and severe renal dysfunction was higher than that in the other three groups （P〈 0.05）. The DI in the groups with mild,moderate and severe renal dysfunction was significantly higher than that in the normal renal function group（ P〈0.05 ）. （ 3 ） Ccr was negatively corre
出处
《中华内分泌代谢杂志》
CAS
CSCD
北大核心
2009年第5期501-505,共5页
Chinese Journal of Endocrinology and Metabolism
关键词
糖尿病
2型
内生肌酐清除率
胰岛素敏感性
胰岛素抵抗
胰岛Β细胞功能
Diabetes mellitus,type 2
Creatinine clearance rate
Insulin sensitivity
Insulin resistance
Islet β-cell secretary function
