Lundberg Rachel, Beilman Gregory J, Dunn Ty B, Pruett Tim L, Freeman Martin L, Ptacek Peggy E, Berry Katherine Louise, Robertson R Paul, Moran Antoinette, Bellin Melena D
From the Departments *Pediatrics, †Surgery, and ‡Medicine, University of Minnesota, Minneapolis, MN.
Pancreas. 2016 Apr;45(4):565-71. doi: 10.1097/MPA.0000000000000491.
Diabetes mellitus is a frequent consequence of chronic pancreatitis (CP). Little is known about pancreatic endocrine function before the development of diabetes mellitus in CP, particularly in females, or those without calcific and/or alcoholic pancreatitis.
Twenty-five nondiabetic adult patients with CP (19 female; mean [SE] age, 34.2 [2.4] years) were compared with 25 healthy controls matched for age, sex, and body mass index. Subjects underwent frequent sample intravenous glucose tolerance testing (FSIVGTT) and mixed meal tolerance testing (MMTT).
Mean (SE) fasting glucose was higher in patients with CP (89.5 [2.3] mg/dL) than in controls (84.4 [1.2] mg/dL, P = 0.04). On MMTT, patients with CP had a higher area under the curve (AUC) glucose and AUC glucagon compared with controls (P ≤ 0.01). The AUC C-peptide was equivalent (P = 0.6) but stimulated C-peptide at 30 minutes was lower in patients with CP (P = 0.04). Mean insulin sensitivity index calculated from the FSIVGTT was lower in CP group, indicating reduced insulin sensitivity (P ≤ 0.01). Disposition index (insulin secretion adjusted for insulin sensitivity on FSIVGTT) was lower in patients with CP (P = 0.01).
Patients with CP had higher fasting and MMTT glucose levels, without a compensatory increase in insulin secretion suggesting subtle early islet dysfunction. Our cohort had relative hyperglucagonemia and was less insulin sensitive than controls.
糖尿病是慢性胰腺炎（CP）的常见后果。对于CP患者在糖尿病发生之前的胰腺内分泌功能，尤其是女性患者或无钙化和/或酒精性胰腺炎患者的胰腺内分泌功能，人们了解甚少。
将25例非糖尿病成年CP患者（19例女性；平均[标准误]年龄为34.2[2.4]岁）与25例年龄、性别和体重指数相匹配的健康对照者进行比较。受试者接受了频繁采样静脉葡萄糖耐量试验（FSIVGTT）和混合餐耐量试验（MMTT）。
CP患者的平均（标准误）空腹血糖（89.5[2.3]mg/dL）高于对照组（84.4[1.2]mg/dL，P = 0.04）。在MMTT中，CP患者的葡萄糖曲线下面积（AUC）和胰高血糖素AUC均高于对照组（P≤0.01）。C肽AUC相当（P = 0.6），但CP患者30分钟时的刺激后C肽水平较低（P = 0.04）。根据FSIVGTT计算的CP组平均胰岛素敏感性指数较低，表明胰岛素敏感性降低（P≤0.01）。CP患者的处置指数（根据FSIVGTT对胰岛素敏感性进行调整后的胰岛素分泌）较低（P = 0.01）。
CP患者的空腹和MMTT血糖水平较高，且胰岛素分泌没有代偿性增加，提示早期存在细微的胰岛功能障碍。我们的队列存在相对高胰高血糖素血症，且胰岛素敏感性低于对照组。
