本文選題：2型糖尿病 + 胰島素�。� 參考：《蘇州大學(xué)》2015年碩士論文

【摘要】：目的:觀察初發(fā)2型糖尿病患者西格列汀治療后胰高血糖素(glucagon)及胰島素(insulin)的動態(tài)變化;探討胰高血糖素在初發(fā)2型糖尿病患者發(fā)病過程中的作用機制。方法:2型糖尿病組50例,在我院門診及住院就診的初發(fā)2型糖尿病患者,其HbA1c≤10%,FBG≥7.0mmol/L,2hPG≥11.1mmol/L,最高血糖≤20.0mmol/L,依據(jù)WHO(1999年)推薦的糖尿病診斷標準。上訴患者均未使用影響胰島素敏感性及糖代謝的藥物(如糖皮質(zhì)激素、利尿劑及β受體阻斷劑等),無應(yīng)激及胃腸疾病和胃腸手術(shù)史。健康對照組48例,均無任何內(nèi)分泌及代謝病史。所有受試者空腹12小時,次日清晨空腹測量身高、體重、血壓,抽取空腹靜脈血,測血清總膽固醇、甘油三酯、低密度脂蛋白膽固醇、高密度脂蛋白膽固醇水平。健康對照組和糖尿病組分別于5 min內(nèi)服完溶于350 mL純水中的75 g葡萄糖粉。于空腹及糖負荷后30min、60min、120min、180min分別抽取靜脈血,同步測血糖、胰高血糖素和胰島素水平。糖尿病組予磷酸西格列汀100mg口服,每日一次。3個月后行糖負荷試驗,于空腹及服糖后30min、60min、120min、180min抽取靜脈血同步測血糖、胰高血糖素和胰島素水平。數(shù)據(jù)以均數(shù)±標準差(x±s)表示,組間比較采用t檢驗,采用SPSS 13.0統(tǒng)計軟件進行處理,p0.05為差異有統(tǒng)計學(xué)意義。數(shù)據(jù)請仔細校對,我僅指出一處,其他你自己看看,包括正文中的結(jié)果:(1)糖尿病組的空腹及餐后各時相的血糖水平都較健康對照組升高[0h:(9.5?0.9)mmol/l vs(5.1?0.3)mmol/l,30min:(10.1?0.9)mmol/l vs(6.3?0.3)mmol/l,60min:(15.3?1.3)mmol/l vs(7.8?0.3)mmol/l,120min:(12.3?1.0)mmol/l vs(5.9?0.2)mmol/l,180min:(8.7?0.7)mmol/l vs(4.7?0.1)mmol/l](P0.05);糖尿病組各時相胰高血糖素水平顯著高于健康對照組[0h:(149.2?7.8)ng/l vs(132.3?4.3)ng/l,30min:(188.1?8.5)ng/l vs(112.7?3.6)ng/l,60min:(204.6?10.3)ng/l vs(105.8?3.4)ng/l,120min:(158.2?9.2)ng/l vs(121.5?3.8)ng/l,180min:(142.1?9.0)ng/l vs(127.4?3.9)ng/l](P0.05)],且糖尿病組服用葡萄糖后胰高血糖素水平明顯升高,60min顯著高于其空腹水平(P0.05),180min基本恢復(fù)到空腹水平。正常人組服用葡萄糖后60min略有下降,后各時相逐漸上升,180min稍低于空腹水平,各時相變化差異均無顯著性(P0.05);糖尿病病人服用葡萄糖后胰島素水平較正常人相比出現(xiàn)明顯高峰延遲,且30min及60min時相明顯低于正常人[30min:(12.5?1.1)mU/l vs(53.3?3.5)mU/l,60min:(27.5?3.8)mU/l vs(68.2?3.8)mU/l](P0.05、0.01)]。糖尿病病人服用葡萄糖后胰島素水平上升緩慢,餐后60 min和120 min顯著高于其空腹水平(P0.05),180 min時基本恢復(fù)到30 min水平;正常人餐后胰島素水平快速上升,60min達到高峰(P0.01),180min時基本恢復(fù)到空腹水平。(2)西格列汀治療三個月后患者血糖水平明顯低于治療前[0h:(7.3?0.8)mmol/l vs(9.5?0.9)mmol/l,30min(9.2?1.1)mmol/l vs(10.1?0.9)mmol/l,60min:(12.2?1.2)mmol/l vs(15.3?1.3)mmol/l,120min:(10.7?0.9)mmol/l vs(12.3?1.0)mmol/l,180min:(7.1?0.7)mmol/l vs(8.7?0.7)mmol/l,](P0.05);治療后各時相胰高血糖素水平低于治療前水平[0h:(141.8?6.6)ng/l vs(149.2?7.8)ng/l,30min:(162.7?6.9)ng/l vs(188.1?8.5)ng/l,60min:(182.4?7.8)ng/l vs(204.6?10.3)ng/l,120min:(147.9?7.0)ng/l vs(158.2?9.2)ng/l,180min:(133.5?7.3)ng/l vs(142.1?9.0)ng/l](P0.05);治療后胰島素水平高于治療前水平[0h:(8.9?1.0)mU/l vs(8.2?0.9)mU/l,30min:(17.5?1.2)mU/l vs(12.5?1.1)mU/l,60min:(33.8?1.2)mU/l vs(27.5?3.8)mU/l,120min:(48.5?1.5)mU/l vs(32.9?2.7)mU/l,180min:(16.7?1.9)mU/l vs(14.5?1.4)mU/l]。結(jié)論:1.初發(fā)2型糖尿病患者較健康對照組有更高的胰高血糖素水平,胰島素其各時相水平明顯低于健康對照組,且高峰延遲,提示β細胞、α細胞功能異常導(dǎo)致胰島素、胰高血糖素的失衡是2型糖尿病患者高血糖發(fā)生、發(fā)展的重要病理生理基礎(chǔ)。2.西格列汀治療三個月后在控制血糖的同時顯著改善胰島素、胰高血糖素分泌的失衡,改善了胰島α、β細胞功能,具有重要的臨床應(yīng)用價值。
[Abstract]:Objective: To observe the dynamic changes of glucagon (glucagon) and insulin (insulin) after Sig Leo Dean treatment in patients with primary type 2 diabetes, and to explore the mechanism of glucagon in the onset of type 2 diabetes. Method: 50 cases of type 2 diabetes mellitus in the outpatient and hospitalized patients with type 2 diabetes in our hospital, the HbA1c < 10%, FBG > 7.0mmol/L, 2hPG > 11.1mmol/L, the highest blood sugar is less than 20.0mmol/L. According to the diabetes diagnostic criteria recommended by WHO (1999), the appellate patients have not used drugs that affect insulin sensitivity and glucose metabolism (such as glucocorticoids, diuretics and beta blockers), without stress and the history of gastrointestinal diseases and gastrointestinal surgery. Healthy control group 48 All subjects had no history of endocrine and metabolic disease. All the subjects were empty stomach for 12 hours. The following morning, the height, weight, blood pressure, fasting venous blood were measured on the fasting morning. The serum total cholesterol, triglycerides, low density lipoprotein cholesterol and high density lipoprotein cholesterol levels were measured. The healthy control group and the diabetic group were dissolved in 350 m in 5 min, respectively. L 75 g grape sugar powder in pure water. Venous blood was extracted from 30min, 60min, 120min, 180min after empty stomach and sugar load respectively. Blood glucose, glucagon and insulin level were measured synchronously. The diabetic group was given oral ciceretine phosphate 100mg. After one month.3 months, the sugar load test was performed. The venous blood was extracted from the fasting and after taking sugar 30min, 60min, 120min, 180min. Synchronously measured blood sugar, glucagon and insulin level. The data were expressed with mean standard deviation (x + s), t test was used and SPSS 13 statistical software was used. The difference was statistically significant. Please proofread the data carefully. I only pointed out one place, and other you, including the results in the text: (1) the diabetes group was empty. [0h: (9.5? 0.9) mmol/l vs (5.1? 0.3) mmol/l, 30min: (10.1? 0.9) mmol/l vs (6.3? 0.3) mmol/l, 60min: (15.3? 1.3) mmol/l vs (7.8? 0.3) Hyperglycemic level was significantly higher than that of [0h: (149.2? 7.8) ng/l vs (132.3? 4.3) ng/l, 30min: (188.1? 8.5) ng/l vs (112.7? 3.6) ng/l, 60min: (204.6? 10.3) ng/l vs (105.8? 3.4) ng/l, and diabetes group after taking glucose The level of glucosin was significantly higher, 60min was significantly higher than the fasting level (P0.05), and 180min was basically restored to the fasting level. The 60min decreased slightly in the normal group after taking glucose, and the phase phase gradually increased, and the 180min was slightly lower than the fasting level. The difference of each phase was not significant (P0.05); the insulin level of diabetic patients after taking glucose was more positive. 30min and 60min were significantly lower than those of normal people, and 30min and 60min were significantly lower than normal people [30min: (12.5? 1.1) mU/l vs (53.3? 3.5) mU/l, 60min: (27.5? 3.8) mU/l vs (68.2? 3.8) mU/l] (P0.05,0.01)]. The insulin levels of diabetic patients increased slowly, 60 and 120 after meals were significantly higher than their fasting levels, 180. The basic recovery was to 30 min level, the normal level of insulin after meal increased rapidly, 60min reached its peak (P0.01), and 180min was basically restored to the fasting level. (2) the blood glucose level of patients after three months of Sig Leo Dean treatment was significantly lower than [0h: (7.3? 0.8) mmol/l vs (9.5? 0.9) mmol/l before treatment, 30min (9.2? 1.1) mmol/l vs (10.1? 0.9) mmol/l, 12.2? 1.2) Mmol/l vs (15.3? 1.3) mmol/l, 120min: (10.7? 0.9) mmol/l vs (12.3? 1) mmol/l, 180min: (7.1? 0.7) mmol/l vs (8.7? 0.7) mmol/l,] (P0.05); after treatment, the level of glucagon is lower than before treatment (141.8? 6.6) 20min: (147.9? 7) ng/l vs (158.2? 9.2) ng/l, 180min: (133.5? 7.3) ng/l vs (142.1? 9) ng/l] (P0.05); after treatment, insulin levels are higher than before the treatment level [0h: (8.9? 1) mU/l vs (8.2? 0.9). MU/l vs (14.5? 1.4) mU/l]. conclusion: 1. patients with type 2 diabetes have higher glucagon levels than those in the healthy control group. The levels of insulin are significantly lower than those in the healthy control group, and the peak delay is delayed, suggesting that the abnormal function of the beta cells, the abnormal function of the alpha cells, is the occurrence of hyperglycemia in type 2 diabetic patients. The important pathophysiological basis,.2. ciceretine, can improve insulin and glucagon secretion and improve the function of pancreatic islet alpha and beta cells after three months of control of blood glucose, which has important clinical value.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R587.1

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