探討2型糖尿病酮癥和非酮癥患者胰島β細(xì)胞功能的差異
發(fā)布時(shí)間：2019-04-27 20:14
【摘要】：目的:比較2型糖尿病酮癥患者和非酮癥患者胰島β細(xì)胞功能的差異。方法:選取2012年6月至2016年12月在廣西醫(yī)科大學(xué)第一附屬醫(yī)院住院治療的2型糖尿病患者作為研究對(duì)象。以上2型糖尿病患者均符合1999年WHO糖尿病的診斷標(biāo)準(zhǔn)診斷,患者無代謝性酸中毒、高滲狀態(tài)、饑餓、感染、手術(shù)、外傷等情況,并除外1型糖尿病、妊娠糖尿病及其它特殊類型糖尿病。符合上述標(biāo)準(zhǔn)的2型糖尿病患者共132例,根據(jù)尿酮或血酮體是否陽性分為非酮癥組與酮癥組,其中,非酮癥組62例,酮癥組70例。上述患者均測(cè)量并記錄一般情況如性別、年齡、身高、體重,次日清晨采血測(cè)糖化血清蛋白、糖化血紅蛋白、總膽固醇、甘油三酯、高密度脂蛋白膽固醇、低密度脂蛋白膽固醇,住院期間予胰島素、藥物降糖治療,以4.4FPG7.0mmol/L,2hPG10.0mmol/L為目標(biāo),患者尿酮或血酮體轉(zhuǎn)陰后行口服葡萄糖耐量試驗(yàn)、C肽釋放試驗(yàn),計(jì)算HOMA-IR、HOMA-β,計(jì)算血糖曲線下面積、C肽曲線下面積。結(jié)果:1.酮癥組的糖化血紅蛋白、糖化血清蛋白較非酮癥組高,差別有統(tǒng)計(jì)學(xué)意義(P0.01)。2.酮癥組的總膽固醇、甘油三酯水平較非酮癥組高,差別有統(tǒng)計(jì)學(xué)意義(P0.05);兩組間的高密度脂蛋白膽固醇、低密度脂蛋白膽固醇差別無統(tǒng)計(jì)學(xué)意義(P0.05)。3.兩組間的空腹血葡萄糖、口服葡萄糖耐量試驗(yàn)30min血葡萄糖差別無統(tǒng)計(jì)學(xué)差異(P0.05);酮癥組的口服葡萄糖耐量試驗(yàn)60min、120min、180min血葡萄糖測(cè)定高于非酮癥組,差別有統(tǒng)計(jì)學(xué)意義(P0.05)。酮癥組的PG-AUC值大于非酮癥組,差別有統(tǒng)計(jì)學(xué)意義(P0.05)。4.非酮癥組的空腹C肽、30minC肽、60minC肽、120minC肽均高于酮癥組,差別具有統(tǒng)計(jì)學(xué)意義(P0.01);兩者的180minC肽差異無統(tǒng)計(jì)學(xué)意義(P0.05)。非酮癥組的CP-AUC值大于酮癥組,差別有統(tǒng)計(jì)學(xué)意義(P0.05)非酮癥組的C肽釋放高峰在120min,酮癥組的C肽釋放高峰在180min甚至更往后的時(shí)間。5.酮癥組的HOMA-IR值大于非酮癥組,差別有統(tǒng)計(jì)學(xué)意義(P0.05),即酮癥組的胰島素抵抗更加明顯;非酮癥組HOMA-β大于酮癥組,差別具有統(tǒng)計(jì)學(xué)意義(P0.01),即酮癥組的胰島素分泌功能更弱。結(jié)論:2型糖尿病酮癥患者的胰島β細(xì)胞功能較非酮癥患者差;2型糖尿病酮癥患者的糖毒性、脂毒性較非酮癥患者明顯。
[Abstract]:Objective: to compare the 尾-cell function between type 2 diabetic ketosis and non-ketosis. Methods: type 2 diabetic patients admitted to the first affiliated Hospital of Guangxi Medical University from June 2012 to December 2016 were selected as subjects. The above-mentioned patients with type 2 diabetes meet the diagnostic criteria of WHO diabetes mellitus in 1999. The patients have no metabolic acidosis, hypertonic state, hunger, infection, surgery, trauma, etc., with the exception of type 1 diabetes mellitus. Gestational diabetes mellitus and other special types of diabetes. 132 patients with type 2 diabetes were divided into non-ketosis group and ketosis group according to whether urine ketones or blood ketones were positive, including 62 cases of non-ketosis group and 70 cases of ketosis group. These patients were measured and recorded in general terms such as sex, age, height, weight, blood samples for glycosylated serum protein, glycosylated hemoglobin, total cholesterol, triglycerides, and high density lipoprotein cholesterol the next morning. Low-density lipoprotein cholesterol (LDL-C) was treated with insulin during hospitalization, taking 4.4 FPG 7.0 mmol / L, 2h PG10.0mmol / L as the target. Oral glucose tolerance test and C-peptide release test were performed after conversion of urinary ketones or blood ketones. HOMA-IR,HOMA- 尾 was calculated, area under blood glucose curve and area under C peptide curve were calculated. Results: 1. The glycosylated hemoglobin and glycosylated serum protein in ketosis group were higher than those in non-ketosis group (P0.01). The levels of total cholesterol and triglyceride in ketosis group were higher than those in non-ketosis group (P0.05), but there was no significant difference in HDL-C and LDL-C between the two groups (P0.05). There was no significant difference between the two groups in fasting blood glucose and oral glucose tolerance test (30min) (P0.05). The oral glucose tolerance test in ketosis group was higher than that in non-ketosis group at 60 min, 120 min, 180 min, and the difference was statistically significant (P0.05). The PG-AUC of ketosis group was higher than that of non-ketosis group, the difference was statistically significant (P0.05). The fasting C peptide, 30 min C peptide, 60 min C peptide, 120 min C peptide in non-ketosis group were significantly higher than those in ketosis group (P0.01), but there was no significant difference in 180minC peptide between the two groups (P0.05). The CP-AUC value of the non-ketosis group was higher than that of the ketosis group, the difference was statistically significant (P0.05) the peak of C-peptide release in the non-ketosis group was at 120 min, and the C-peptide release peak in the ketosis group was even longer than that in the ketosis group. 5. The HOMA-IR value of ketosis group was higher than that of non-ketosis group, the difference was statistically significant (P0.05), that is, the insulin resistance of ketosis group was more obvious than that of non-ketosis group. The HOMA- 尾 in the non-ketosis group was higher than that in the ketosis group, and the difference was statistically significant (P0.01), that is, the insulin secretion function in the ketosis group was weaker than that in the ketosis group. Conclusion: the 尾-cell function of type 2 diabetic ketosis patients is worse than that of non-ketotic patients, and the glucotoxicity and lipotoxicity of type 2 diabetic ketosis patients is more obvious than that of non-ketotic patients.
【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】：2017
【分類號(hào)】：R587.2
本文編號(hào)：2467275
[Abstract]:Objective: to compare the 尾-cell function between type 2 diabetic ketosis and non-ketosis. Methods: type 2 diabetic patients admitted to the first affiliated Hospital of Guangxi Medical University from June 2012 to December 2016 were selected as subjects. The above-mentioned patients with type 2 diabetes meet the diagnostic criteria of WHO diabetes mellitus in 1999. The patients have no metabolic acidosis, hypertonic state, hunger, infection, surgery, trauma, etc., with the exception of type 1 diabetes mellitus. Gestational diabetes mellitus and other special types of diabetes. 132 patients with type 2 diabetes were divided into non-ketosis group and ketosis group according to whether urine ketones or blood ketones were positive, including 62 cases of non-ketosis group and 70 cases of ketosis group. These patients were measured and recorded in general terms such as sex, age, height, weight, blood samples for glycosylated serum protein, glycosylated hemoglobin, total cholesterol, triglycerides, and high density lipoprotein cholesterol the next morning. Low-density lipoprotein cholesterol (LDL-C) was treated with insulin during hospitalization, taking 4.4 FPG 7.0 mmol / L, 2h PG10.0mmol / L as the target. Oral glucose tolerance test and C-peptide release test were performed after conversion of urinary ketones or blood ketones. HOMA-IR,HOMA- 尾 was calculated, area under blood glucose curve and area under C peptide curve were calculated. Results: 1. The glycosylated hemoglobin and glycosylated serum protein in ketosis group were higher than those in non-ketosis group (P0.01). The levels of total cholesterol and triglyceride in ketosis group were higher than those in non-ketosis group (P0.05), but there was no significant difference in HDL-C and LDL-C between the two groups (P0.05). There was no significant difference between the two groups in fasting blood glucose and oral glucose tolerance test (30min) (P0.05). The oral glucose tolerance test in ketosis group was higher than that in non-ketosis group at 60 min, 120 min, 180 min, and the difference was statistically significant (P0.05). The PG-AUC of ketosis group was higher than that of non-ketosis group, the difference was statistically significant (P0.05). The fasting C peptide, 30 min C peptide, 60 min C peptide, 120 min C peptide in non-ketosis group were significantly higher than those in ketosis group (P0.01), but there was no significant difference in 180minC peptide between the two groups (P0.05). The CP-AUC value of the non-ketosis group was higher than that of the ketosis group, the difference was statistically significant (P0.05) the peak of C-peptide release in the non-ketosis group was at 120 min, and the C-peptide release peak in the ketosis group was even longer than that in the ketosis group. 5. The HOMA-IR value of ketosis group was higher than that of non-ketosis group, the difference was statistically significant (P0.05), that is, the insulin resistance of ketosis group was more obvious than that of non-ketosis group. The HOMA- 尾 in the non-ketosis group was higher than that in the ketosis group, and the difference was statistically significant (P0.01), that is, the insulin secretion function in the ketosis group was weaker than that in the ketosis group. Conclusion: the 尾-cell function of type 2 diabetic ketosis patients is worse than that of non-ketotic patients, and the glucotoxicity and lipotoxicity of type 2 diabetic ketosis patients is more obvious than that of non-ketotic patients.
【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】：2017
【分類號(hào)】：R587.2
【參考文獻(xiàn)】
相關(guān)期刊論文 前3條
1 嚴(yán)丹;馬曉松;;微絲細(xì)胞骨架重塑異常與糖毒性所致胰島β細(xì)胞分泌功能障礙[J];中華糖尿病雜志;2014年08期
2 鄒玲玲;魯紅云;曾映娟;羅順葵;孫瑩;劉紅;孫遼;謝丹紅;;酮癥和非酮癥起病的新診斷2型糖尿病胰島功能比較[J];中華糖尿病雜志;2013年12期
3 李霞,周智廣,亓海英,陳小燕,黃干;用空腹C肽代替胰島素改良Homa公式評(píng)價(jià)胰島素抵抗和胰島β細(xì)胞功能[J];中南大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2004年04期
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