【摘要】 目的:探讨真胰岛素(T I)和免疫反应性胰岛素(IR I)水平在反映胰岛β细胞功能和胰岛素抵抗方面的不同。方法:对141例受试者行精氨酸刺激试验,分别测定各时点血糖(PG)、T I、IR I及胰岛素原(P I),其中正常糖耐量(NGT)组35例、2型糖尿病(T 2DM)组106例,用精氨酸刺激试验后T I/PG、(T I+P I)/PG和IR I/PG的增值及曲线下面积来评价β细胞功能。结果:①T I/PG与(T I+P I)/PG及IR I/PG的增值无论在NGT组还是T 2DM组均有相关性(r=0.68~0.99,均P<0.01),其曲线下面积亦有类似现象(r=0.62~0.99,均P<0.01)。②T I/PG的增值与曲线下面积在NGT组和T 2DM组均相关(r分别为0.96、0.82,均P<0.01)。③以T I、(T I+P I)和IR I分别计算的HOMA-IR在T 2DM组明显高于NGT组(均P<0.01)。④精氨酸刺激试验结果证实T 2DM病理生理改变主要表现为胰岛素抵抗伴分泌不足。结论:T I较IR I更能客观地反映T 2DM患者β细胞功能状态和胰岛素抵抗程度,但在无条件检测T I的情况下IR I也可推广使用,从而指导临床实践。更多还原

【Abstract】 Objective: To investigate the difference between serum true insulin（TI） and immunoreactive insulin（IRI） in evaluating islet β-cell function and insulin resistance.Methods: The arginine stimulation test was performed in 141 individuals,including 35 with normal glucose tolerance（NGT） and 106 with type 2 diabetes（T2DM）.Plasma glucose（PG）,TI,IRI and proinsulin（PI） levels were measured;the incremental value of TI/PG,（TI+PI）/PG and IRI/PG（ΔTI/PG,Δ（TI+PI）/PG and ΔIRI/PG） and the area under curve of TI/PG,（TI+PI）/PG and IRI/PG（AUC,AUC[（TI+PI）/PG] and AUC[IRI/PG]） after arginine stimulation were calculated to evaluate β-cell function.Results: There were positive correlations of ΔTI/PG with Δ（TI+PI）/PG and ΔIRI/PG in both NGT and T2DM patients（r=0.68～0.99,P<0.01）.The similar correlations of AUC with AUC[（TI+PI）/PG] and AUC[IRI/PG] were also shown（r=0.62～0.99,P<0.01）.ΔTI/PG was correlated with AUC in two groups（NGT r=0.96,T2DM r=0.82,P<0.01）.HOMAIR_TI,HOMA-IR_（TI+PI） and HOMA-IR_IRI in T2DM were higher than those in NGT（P<0.01）.After arginine stimulation T2DM subjects mainly presented insulin resistance and decreased insulin secretion.Conclusion: The determination of TI may be more accurate than IRI in evaluating βcell function and insulin resistance.更多还原