本文選題：類固醇性糖尿病 + 2型糖尿病�。� 參考：《廣西醫(yī)科大學(xué)》2016年碩士論文

【摘要】：目的：了解類固醇性糖尿病(steroid diabetes mellitus, SDM)患者胰島功能情況,尤其是胰島素1相分泌功能的變化情況,探討胰島素1相分泌在SDM與T2DM鑒別診斷中的價(jià)值,為臨床提供更多診斷依據(jù)及指導(dǎo)治療。方法：選取2011年1月至2016年3月在廣西醫(yī)科大學(xué)第一附屬醫(yī)院住院的皮質(zhì)醇增多癥患者60例(男性34例,女性26例),其中庫欣綜合征(Cushing's syndrome, CS)患者25例(男性3例,女性22例),醫(yī)源性CS患者35例(其中男性31例,女性4例),同時(shí)收集69例為對(duì)照(男性48例,女性21例)。根據(jù)OGTT結(jié)果將皮質(zhì)醇增多癥組分為：①類固醇性糖尿病組(SDM)；②皮質(zhì)醇增多癥葡萄糖調(diào)節(jié)受損組(hypercortisolism IGR, HIGR)；③皮質(zhì)醇增多癥正常葡萄糖耐量組(hypercortisolism normal glucose tolerance, HNGT)。將對(duì)照組分為：①T2DM組；②IGR組；③NGT組。收集研究對(duì)象的臨床資料,包括性別、年齡、病程、身高、體重、收縮壓(Systolic blood pressure, SBP)、舒張壓(Diastolic blood pressure, DBP)、血脂、肝功、糖化血紅蛋白(Glycosylated hemoglobin, HbAlc),同時(shí)行OGTT、IVGTT。IVGTT急性時(shí)相胰島素分泌(The acute phase of insulin secretion, AIR0-10min)、胰島素曲線下面積(Area under the curve of insulin, AUCins0-10min)評(píng)估胰島素1相分泌功能；使用OGTT胰島素抵抗指數(shù)(Homeostasis model assessment of insulin resistance, HOMA-IR)評(píng)估胰島素抵抗?fàn)顟B(tài)；OGTT胰島素曲線下面積(AUCins0.3h)、胰島素曲線下面積／血糖曲線下面積(Area under the curve of glucose, AUCglu)(AUCins/AUCgluo-3h)評(píng)估胰島素2相分泌功能,同時(shí)聯(lián)合OGTT修正的胰島p細(xì)胞功能指數(shù)(Modified beta cell function index, MBCI)、胰島素分泌功能指數(shù)(Homeostasis model assessment of insulin secretion, HOMA-p)以及OGTT、IVGTT的峰值胰島素(Peak insulin, Ip)／基礎(chǔ)胰島素(Fasting insulin, Io) (Ip/Io)指標(biāo)來評(píng)估胰島p細(xì)胞分泌功能狀態(tài)。探討SDM與T2DM胰島功能有無差別,尤其是胰島素1相分泌功能。結(jié)果：1、皮質(zhì)醇增多癥患者中,DM、IGR、NGT比例分別為43.3%、33.3%、23.3%；SDM中單純空腹血糖升高、單純餐后血糖升高及空腹和餐后均升高比例分別為7.7%、69.2%、23.1%；存在高血壓患者達(dá)65.0%,SDM發(fā)病年齡早于T2DM, SDM患者TC、HDL及血壓均高于T2DM;2、OGTT中,皮質(zhì)醇增多癥組HOMA-IR、HOMA-β均較相應(yīng)的對(duì)照組高,但二者間比較差異均無統(tǒng)計(jì)學(xué)意義(P均0.05)；皮質(zhì)醇增多癥組中的IGR、DM組的AUCins0-3h、AUCins/AUCgluo-3h分別高于相應(yīng)對(duì)照IGR, DM組,差異有統(tǒng)計(jì)學(xué)意義(P0.05); SDM組的Ip高于T2DM組(P0.05)；在對(duì)照組中,NGT組的MBCI高于IGR、DM組,(P0.05)。3、IVGTT中,除T2DM組胰島分泌呈低平曲線、無明顯分泌高峰外,余各組胰島素峰值大部分出現(xiàn)在2～4min, SDM組的Ip、Ip/I0、AIR0-10min、AUCins0-10min均高于T2DM,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論：1、皮質(zhì)醇增多癥患者中,類固醇性糖尿病發(fā)病率高,發(fā)病年齡相對(duì)T2DM早,且以餐后血糖升高為主,多數(shù)伴有血壓升高。2、類固醇性糖尿病患者胰島分泌功能優(yōu)于2型糖尿病,其1相分泌功能仍存在,尤其是IVGTT檢測(cè)中的Ip/I0可作為類固醇性糖尿病與2型糖尿病鑒別診斷的指標(biāo)。
[Abstract]:Objective: to understand the islet function of patients with steroid diabetes mellitus (SDM), especially the changes in the 1 phase secreting function of insulin, and to explore the value of insulin 1 phase secretion in the differential diagnosis of SDM and T2DM, to provide more diagnostic basis and guidance for clinical treatment. Methods: from January 2011 to March 2016. 60 cases of polycythemia in the First Affiliated Hospital of Guangxi Medical University (34 males and 26 females) were found in the First Affiliated Hospital of Guangxi Medical University, including 25 cases of Cushing syndrome (Cushing's syndrome, CS) and 35 cases of iatrogenic CS (including 31 males and 4 women), and 69 cases (male 48, female 21). According to OGTT knot The corticosteroid group was divided into three groups: (1) steroid diabetic group (SDM); (2) the impaired glucose regulation group (hypercortisolism IGR, HIGR) of cortisol; (3) the normal glucose tolerance group (hypercortisolism normal glucose tolerance, HNGT). (1) the control group was divided into: (1) T2DM group; (2) IGR group; (3) NGT group. The clinical data of the subjects were collected, including sex, age, course of disease, height, weight, Systolic blood pressure (SBP), diastolic pressure (Diastolic blood pressure, DBP), blood lipid, liver function, glycosylated hemoglobin (Glycosylated hemoglobin, HbAlc). N secretion, AIR0-10min), the area under the insulin curve (Area under the curve of insulin, AUCins0-10min) assessed the 1 phase secreting function of insulin; the islet resistance state was evaluated using the OGTT insulin resistance index. The area under the islet curve (Area under the curve of glucose, AUCglu) (AUCins/AUCgluo-3h) assessed the 2 secretory function of insulin, and combined the OGTT modified islet P cell function index (Modified beta) and the islet secretory function index. Cretion, HOMA-p) and OGTT, IVGTT (Peak insulin, Ip) / basal insulin (Fasting insulin, Io) (Ip/Io) index to evaluate the secretory function of islet P cells. For 43.3%, 33.3%, 23.3%, the increase in simple fasting blood glucose in SDM was 7.7%, 69.2%, 23.1%, respectively, and 65% in patients with hypertension, the age of SDM was earlier than that of T2DM, TC, HDL, and blood pressure in SDM patients were higher than T2DM; 2, OGTT, and cortisol group HOMA-IR and HOMA- beta were corresponding to the corresponding pairs. There was no statistically significant difference between the two groups (P 0.05), and IGR in the cortisol group, AUCins0-3h in group DM and AUCins/AUCgluo-3h in group DM, respectively, with statistical significance (P0.05), and Ip in the SDM group was higher than that in the T2DM group (P0.05). In addition to the low level secretion of islet secretion in group T2DM and no obvious secretory peak, most of the peaks of insulin in the remaining groups were 2 to 4min, Ip, Ip/I0, AIR0-10min, AUCins0-10min in group SDM were higher than T2DM, and the difference was statistically significant (P0.05). Conclusion: 1, the incidence of steroid diabetes is high in patients with cortisol, and the age of onset is relatively T. 2DM early, mainly with elevated postprandial blood glucose, mostly accompanied by elevated blood pressure of.2, the islet secretory function of steroid diabetic patients is superior to type 2 diabetes, and its 1 phase secretory function still exists, especially the Ip/I0 in IVGTT detection can be used as an indicator of the differential diagnosis of steroid diabetes and type 2 diabetes.

【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R587.1

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