本文選題：肥胖 + 2型糖尿病�。� 參考：《河北醫(yī)科大學(xué)》2016年碩士論文

【摘要】：目的:觀察不同BMI及不同腰圍(WC)的2型糖尿病患者胰島功能及血清GLP-1和GC水平,探討肥胖與2型糖尿病患者的胰島功能、GLP-1和GC水平的相關(guān)性。方法:選取2015年3月~2015年11月,于河北醫(yī)科大學(xué)第三醫(yī)院就診的2型糖尿病患者85例,依據(jù)BMI將研究對象分為正常BMI組、超重組和肥胖組;依據(jù)WC分為腹型肥胖(Abdominal obesity,AO)組和非腹型肥胖(Non-abdominal obesity,NAO)組。所有受試者均于禁食8~12小時后行口服75g葡萄糖耐量試驗(yàn)(oral glucose tolerance test,OGTT),分別采集0、30min、120min時的肘靜脈血,檢測各時間點(diǎn)血樣的血糖(BG)、胰島素(INS)、C肽(CP)、胰高血糖素樣肽-1(GLP-1)和胰高血糖素(GC)水平,并計算胰島素敏感指數(shù)(ISI)、穩(wěn)態(tài)模型胰島素抵抗指數(shù)(HOMA-IR)、穩(wěn)態(tài)模型胰島β細(xì)胞功能指數(shù)(HOMA-β)、早相胰島素分泌指數(shù)(△I30/△G30)和晚相胰島素分泌指數(shù)(AUC_(ins)/AUCg)。結(jié)果:不同BMI組比較:超重組和肥胖組的AUC_(ins)、AUC_(cp)、△I30/△G30、AUC_(ins)/AUCg及HOMA-IR顯著高于正常BMI組(P0.05),ISI顯著低于正常BMI組(P0.05)(見表3、5、7),兩兩比較結(jié)果顯示超重組和肥胖組無明顯差異(P0.05)。各組組內(nèi)三個時間點(diǎn)INS、CP水平依次升高,差異有統(tǒng)計學(xué)意義(P0.001)(見圖1、2);GLP-1水平于服糖后30min達(dá)峰,2h回到基礎(chǔ)水平,組內(nèi)各時間點(diǎn)差異有統(tǒng)計學(xué)意義(P0.05)。超重組、肥胖組三個時間點(diǎn)GC水平隨INS、CP水平的增加較空腹水平出現(xiàn)上升趨勢,但差異未達(dá)到統(tǒng)計學(xué)意義(P0.05);不同WC組比較:AO組AUC_(ins)、AUC_(cp)、HOMA-IR顯著高于NAO組,ISI顯著低于NAO組(P均0.05)(見表4、6、8)。各組組內(nèi)三個時間點(diǎn)INS、CP水平依次升高,差異有統(tǒng)計學(xué)意義(P0.001)(見圖5、6);GLP-1水平于服糖后30min達(dá)峰,2h回到基礎(chǔ)水平,組內(nèi)各時間點(diǎn)差異有統(tǒng)計學(xué)意義(P0.05)。AO組三個時間點(diǎn)GC水平隨INS、CP水平的增加較空腹水平出現(xiàn)上升趨勢,但差異均未達(dá)到統(tǒng)計學(xué)意義(P0.05);相關(guān)分析顯示,BMI與SBP、DBP、TG、FINS、FCP、AUC_(ins)、AUC_(cp)、AUC_(ins)/AUCg及HOMA-IR呈正相關(guān)(相關(guān)系數(shù)分別為0.386、0.274、0.35、0.214、0.336、0.222、0.234、0.288,P均0.05),與HDL-C、ISI呈顯著負(fù)相關(guān)(r=-0.243,-0.288,P0.05,0.01);WC與SBP、DBP、TG、FCP、AUCCP、HOMA-IR存在正相關(guān)(r=0.299、0.352、0.284、0.401、0.262、0.238,P0.05),與HDL-C、ISI存在負(fù)相關(guān)(r=-0.252、-0.234,P0.05);WHR與SBP、DBP、TG、FCP存在正相關(guān)(r=0.328、0.401、0.228、0.257,P0.05),與其他變量無相關(guān)性(P0.05)。進(jìn)一步將BMI、WC及WHR與相關(guān)變量做逐步回歸分析,得到回歸方程:(1)Y_(BMI)=6.131+0.04X_(SBP)+0.146X_(DBP)+1.191 X_(FCP),R~2=34.5%;(2)Y_(WC)=56.57+3.423X_(FCP)+0.322 X_(DBP),R~2=22.8%;(3)Y_(WHR)=0.747+0.002 X_(DBP),R~2=14.9%.P均=0.000,以上三個方程均有統(tǒng)計學(xué)意義。結(jié)論:1隨著BMI和WC的增加(尤其是BMI增加),T2DM患者的胰島素分泌能力代償性增加,提示肥胖T2DM患者存在更明顯的胰島素抵抗,且BMI較WC與胰島素抵抗和胰島素敏感性關(guān)系更密切。2肥胖T2DM患者服糖后各時間點(diǎn)的GC水平隨INS、CP水平的增加有增加趨勢,說明INS抑制GC分泌的作用減弱,提示胰島α細(xì)胞可能存在胰島素抵抗。3超重和肥胖T2DM患者的基礎(chǔ)和葡萄糖刺激后GLP-1水平有降低趨勢。
[Abstract]:Objective: To observe the islet function and serum GLP-1 and GC levels of type 2 diabetic patients with different BMI and different waist circumference (WC), and to explore the correlation between the islet function and the level of GLP-1 and GC in patients with type 2 diabetes. Methods: 85 patients with type 2 diabetes in the Third Hospital of Hebei Medical University in March 2015 were selected according to BMI. The subjects were divided into the normal BMI group, the super recombinant and the obese group. According to the WC, the subjects were divided into abdominal obesity (Abdominal obesity, AO) and non abdominal obesity (Non-abdominal obesity, NAO). All subjects were given the oral 75g glucose tolerance test (oral glucose) after fasting 8~12 hours. Blood blood, blood glucose (BG), insulin (INS), C peptide (CP), glucagon like peptide -1 (GLP-1) and glucagon (GC), insulin sensitivity index (ISI), homeostasis model insulin resistance index (HOMA-IR), stable model islet beta cell function index (HOMA- beta), and early phase insulin secretion index (delta I30/ Delta G30). And late phase insulin secretion index (AUC_ (INS) /AUCg). Results: compared with group BMI, AUC_ (INS), AUC_ (CP), AUC_ (CP), Delta I30/ Delta G30, AUC_ (INS) were significantly higher than those in the normal group (see table). The results showed that there was no significant difference between the group and the obese group. 5) at three time points INS, CP level increased in turn, the difference was statistically significant (P0.001) (see Figure 1,2), GLP-1 level was 30min peak at the level of sugar, 2h returned to the base level, and the difference in time points in the group was statistically significant (P0.05). The level of GC in the three time points of the obese group increased with INS, CP level increased compared with the fasting level. Trend, but the difference was not statistically significant (P0.05), and in group WC, AUC_ (INS), AUC_ (CP), HOMA-IR were significantly higher than group NAO (CP), ISI was significantly lower than NAO group (P mean 0.05). To the basic level, the difference in time points within the group was statistically significant (P0.05) at the three time points of group.AO, the level of GC increased with the level of INS, and the level of CP increased more than that of the fasting level, but the difference was not statistically significant (P0.05). The correlation coefficient is 0.386,0.274,0.35,0.214,0.336,0.222,0.234,0.288, P is 0.05), and it is negatively correlated with HDL-C, ISI (r=-0.243, -0.288, P0.05,0.01). WC and SBP, DBP, TG, FCP. There is a positive correlation (r=0.328,0.401,0.228,0.257, P0.05) and no correlation with other variables (P0.05). Further regression analysis of BMI, WC and WHR and related variables is made to get the regression equation: (1) Y_ (BMI) =6.131+0.04X_ (SBP) +0.146X_ (2); (3) 747+0.002 X_ (DBP), R~2=14.9%.P =0.000, all of the above three equations were statistically significant. Conclusion: 1 with the increase of BMI and WC (especially BMI increase), the insulin secretion ability of T2DM patients is compensatory, suggesting that obese T2DM patients have more obvious insulin resistance, and BMI is more closely related to insulin resistance and insulin sensitivity. The level of GC in each time point of.2 obese T2DM patients increased with the increase of INS and CP levels, indicating that the effect of INS to inhibit the secretion of GC decreased, suggesting that islet alpha cells may have the basis of insulin resistance to.3 overweight and obese T2DM patients and the decreasing trend of GLP-1 level after glucose stimulation.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R587.1

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