[新诊断酮症糖尿病患者胰岛β细胞功能在患病初期及缓解期的分类与预后意义]
[The classification and prognostic implication of islet β cell function before and in remission period in newly diagnosed diabetic patients with ketosis].
作者信息
Fan Hui, Zhang Peng-rui, Liu Jia, Xu Yuan
机构信息
Department of Endocrinology, Capital University of Medical Science, Beijing, China.
出版信息
Zhonghua Nei Ke Za Zhi. 2012 Feb;51(2):108-13.
OBJECTIVE
To observe β cell function in newly diagnosed diabetic patients with ketosis before and in remission period and evaluate its classification and predictive value.
METHODS
A total of 206 patients newly diagnosed as diabetic ketosis who had been treated with intensive insulin therapy in our hospital and entered in the "honeymoon" after the withdraw of insulin therapy were followed for 36 months from onset of diabetes. They were divided into two groups of type 1 and type 2 diabetes (group A and B), according to the dependence or independence on insulin treatment. The β cell function of the two groups before and in remission period was compared by oral glucose tolerance test (OGTT). β cell function was measured with the AUC of insulin and C-peptide and homeostatic model assessment β-cell function (HOMA-β), while homeostatic model assessment insulin resistant (HOMA-IR) for insulin resistant. The duration of the "honeymoon" and the change of insulin and C-peptide curve before and in "honeymoon" were also observed.
RESULTS
The AUC of insulin and C-peptide, the HOMA-β and the HOMA-IR before and after the intensive insulin treatment were lower in group A than that in group B [before the insulin treatment: (10.18 ± 2.36) mIU×h×L(-1) vs (20.28 ± 6.89) mIU×h×L(-1), (1.56 ± 0.53) µg×h×L(-1) vs (3.75 ± 0.67) µg×h×L(-1), 3.68 ± 1.08 vs 18.20 ± 6.59, 1.22 ± 0.49 vs 3.06 ± 1.54, respectively; after the insulin treatment: (29.86 ± 8.65) mIU×h×L(-1) vs (93.35 ± 19.42) mIU×h×L(-1), (3.99 ± 0.79) µg×h×L(-1) vs (12.54 ± 3.83) µg×h×L(-1), 8.50 ± 2.46 vs 56.17 ± 19.42, 0.63 ± 0.56 vs 1.42 ± 0.78, respectively]. The duration of the "honeymoon" in group A was significantly shorter than in group B [(7.9 ± 5.2) months vs (20.9 ± 9.9) months]. In oral glucose insulin and C-peptide release test, the peak of insulin and C-peptide releasing curve in group A was brought forward by a half to 1 hour after intensive treatment while delayed in group B by 1 or 2 hours. The releasing peak of insulin and C-peptide in group A was less than two folds of the basic value, while four to ten fold of the basic value in group B. The positive ratio of glutamic acid decarboxylase antibody, insulin autoantibody and insular cellular antibody in group A and group B were 21.2% vs 4.8%, 18.1% vs 3.3%, 9.2% vs 10.6%, respectively.
CONCLUSIONS
Of all the patients newly diagnosed as diabetes ketosis who had entered into the honeymoon after intensive insulin therapy, 91% were type 2 diabetes. Inferior β cell function before insulin therapy, weaker remission after insulin therapy and shorter duration of remission period suggest the classification of type 1 diabetes.
目的
观察新诊断的糖尿病酮症患者在患病前及缓解期的β细胞功能，并评估其分类及预测价值。
方法
选取我院206例新诊断为糖尿病酮症且接受强化胰岛素治疗后进入“蜜月期”的患者，自糖尿病发病起随访36个月。根据胰岛素治疗的依赖性或独立性将其分为1型糖尿病组和2型糖尿病组（A组和B组）。采用口服葡萄糖耐量试验（OGTT）比较两组患者患病前及缓解期的β细胞功能。通过胰岛素和C肽的曲线下面积（AUC）及稳态模型评估β细胞功能（HOMA-β）来测定β细胞功能，同时采用稳态模型评估胰岛素抵抗（HOMA-IR）来评估胰岛素抵抗情况。还观察了“蜜月期”的持续时间以及“蜜月期”前后胰岛素和C肽曲线的变化。
结果
强化胰岛素治疗前后，A组胰岛素和C肽的AUC、HOMA-β及HOMA-IR均低于B组[胰岛素治疗前：（10.18±2.36）mIU×h×L⁻¹ 对 （20.28±6.89）mIU×h×L⁻¹，（1.56±0.53）μg×h×L⁻¹ 对 （3.75±0.67）μg×h×L⁻¹，3.68±1.08 对 18.20±6.59，1.22±0.49 对 3.06±1.54；胰岛素治疗后：（29.86±8.65）mIU×h×L⁻¹ 对 （93.35±19.42）mIU×h×L⁻¹，（3.99±0.79）μg×h×L⁻¹ 对 （12.54±3.83）μg×h×L⁻¹，8.50±2.46 对 56.17±19.42，0.63±0.56 对 1.42±0.78]。A组“蜜月期”的持续时间显著短于B组[（7.9±5.2）个月 对 （20.9±9.9）个月]。在口服葡萄糖胰岛素和C肽释放试验中，强化治疗后A组胰岛素和C肽释放曲线的峰值提前了半小时至1小时，而B组则延迟了1或2小时。A组胰岛素和C肽的释放峰值低于基础值的两倍，而B组为基础值的四至十倍。A组和B组谷氨酸脱羧酶抗体、胰岛素自身抗体及胰岛细胞抗体的阳性率分别为21.2%对4.8%、18.1%对3.3%、9.2%对10.6%。
结论
在所有新诊断为糖尿病酮症且经强化胰岛素治疗后进入“蜜月期”的患者中，91%为2型糖尿病。胰岛素治疗前β细胞功能较差、胰岛素治疗后缓解较弱且缓解期持续时间较短提示为1型糖尿病。
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