【摘要】 目的　观察 2型糖尿病血糖控制前后胰岛β细胞功能及胰岛素敏感性变化。 方法　 2型糖尿病血糖控制未达标者 ,检查 β细胞功能及胰岛素敏感性。以胰岛素耐量试验 (ITT)中KITT表示胰岛素抵抗程度 ;以标准馒头餐试验中 30min内C肽曲线下面积 (AUCCP30 )及 1 2 0min内C肽曲线下面积(AUCCP1 2 0 )分别反映葡萄糖刺激的胰岛素分泌第一时相变化及总量 ;以精氨酸刺激试验中急性C肽反应(ACRARG)反映非葡萄糖刺激的胰岛素分泌功能。然后控制血糖 ,随访督导 3个月以上 ,复查空腹血糖、餐后血糖、HbA1c并重复上述检测。结果　 30例进入研究 ,2 0例完成。研究结束时 ,随血糖控制改善 ,β细胞功能指标AUCCP30 、AUCCP1 2 0 、ACRARG均升高 ,血清空腹胰岛素原 (PI)及与C肽比例下降 ,胰岛素抵抗程度减轻 ,差异均有显著性。结论　血糖控制可改善胰岛 β细胞葡萄糖刺激的及非葡萄糖刺激的胰岛素分泌功能 ,减少PI分泌绝对及相对数量。血糖控制可改善胰岛素敏感性更多还原

【Abstract】 Objective To in ve stigate the effects of glycemic control on islet β cell function and insulin re sistance in type 2 diabetes. Methods Type 2 dia betic patients with poor glycemic control 〔fasting blood glucose (FBG)≥6.0 mmo l/L, postprandial 2h blood glucose (PG2h)≥8.0 mmol/L, HbA 1c ≥6.2%〕 were selected. Besides anthropometric measurements, insulin tolerance test (ITT), sta ndard steamed bread C-peptide (CP) releasing test (SSBT), arginine (ARG) stimul ation test (AST) as well as fasting proinsulin (PI) assay were performed to meas ure β cell function and insulin sensitivity before and after glycemic control. Such indices as K ITT in ITT, AUC CP30 (AUC: area under curve) and AUC CP120 in SSBT, ACR ARG (ACR: acute C-peptide response) in AST and PI /CP were calculated. Results Thirty patients en tered the study and 20 patients finished whole follow-up. At the end, glycemic control improved 〔HbA 1c (9.75±1.72)% vs (6.96±0.88) %, P<0.01; FBG (9.75±1.22 vs 6.40±1.4 9)mmol/L, P<0.01; PG2h (20.28±5.29 vs 5.89±4.53)mmol/L, P<0.01 before and after the study respec tively〕 without significant anthropometric changes. Indices of β cell function in SSBT and AST were improved 〔AUC CP30 (22087±12691 vs 29723±12218 )pmol·L -1 ·min, P<0.01; AUC CP120 (144 453±93744vs 197726±79417)pmol·L -1 ·min,P<0.01;ACR ARG (452±93 vs 814±125)pmol/L, P<0.01〕 . PI and PI/CP decreased (PI: 36.3±5.02 vs 20.79±2.85, P<0.01; PI/CP: 0.074±0.053 vs 0.025±0.01 5, P<0.01) and meanwhile K ITT also increased (0.73±0 .20 vs 1.95±0.51, P<0.01). Conclusion Glycemic control may improve islet β cell funct ion including glucose stimulated insulin secretion and non-glucose stimulated i nsulin secretion, and reduces absolute and relative amount of PI secretion in ty pe 2 diabetes. Similarly, glycemic control can ameliorate insulin resistance.更多还原