Department of Endocrinology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China.
Department of Endocrinology, Yixing Second People's Hospital, Wuxi 214200, China.
Clin Chim Acta. 2021 Dec;523:81-86. doi: 10.1016/j.cca.2021.09.008. Epub 2021 Sep 14.
Recently, numerous studies validated frequent pancreatic exocrine dysfunction in patients with diabetes. However, the prevalence of pancreatic exocrine insufficiency (PEI) in diabetes mellitus (DM) varies widely among studies. This study aims to determine the prevalence of PEI in Chinese people with type 2 DM (T2DM) by measuring the fecal elastase-1 (FE-1) levels and further identify potential factors that influence pancreatic exocrine function in patients with T2DM.
A total of 85 patients with T2DM without known exocrine pancreatic disorders or digestive system diseases were recruited. Fecal samples were submitted to measure FE-1 levels, and blood samples were collected to investigate pancreatic endocrine function and metabolic biomarkers in all participants. The multiple logistic regression analysis was established to evaluate the influencing factors of PEI in patients with T2DM. The potential predictors of PEI were examined using receiver operating characteristic (ROC) curves.
The prevalence of PEI measured by low FE-1 in T2DM was 18.8%. The Spearman correlation demonstrated that the FE-1 level was inversely correlated with DM duration (r = - 0.360, P = 0.001) and glycated hemoglobin (HbA1c) level (r = - 0.228, P = 0.036). A highly significant positive association was observed between FE-1 and fasting C-peptide (FCP) levels (r = 0.451, P < 0.001). Furthermore, the multiple logistic regression analysis showed that FCP was an independent influencing factor of PEI (OR = 0.204, P = 0.024, 95% CI: 0.051-0.813). The ROC analysis indicated that the FCP level had a predictive value for low FE-1 (AUC = 0.793, P < 0.001) with an optimal cutoff value of 1.20 ng/ml.
Chinese patients with T2DM show high PEI prevalence. FCP may be a potential predictor of pathological exocrine function in T2DM. The exocrine and endocrine functions of patients with T2DM in clinical practice should be evaluated. Further studies are needed to clarify the internal association between exocrine and endocrine pancreases.
最近，许多研究证实糖尿病患者胰腺外分泌功能频繁受损。然而，糖尿病患者胰腺外分泌不足（PEI）的患病率在不同研究中差异很大。本研究旨在通过测量粪便弹性蛋白酶-1（FE-1）水平来确定中国 2 型糖尿病（T2DM）患者中 PEI 的患病率，并进一步确定影响 T2DM 患者胰腺外分泌功能的潜在因素。
共招募了 85 名无已知胰腺外分泌疾病或消化系统疾病的 T2DM 患者。所有参与者均采集粪便样本测量 FE-1 水平，并采集血液样本以研究胰腺内分泌功能和代谢生物标志物。建立多元逻辑回归分析以评估 T2DM 患者中 PEI 的影响因素。使用接收者操作特征（ROC）曲线检查 PEI 的潜在预测因子。
T2DM 患者低 FE-1 测定的 PEI 患病率为 18.8%。Spearman 相关性分析表明，FE-1 水平与糖尿病病程（r=-0.360，P=0.001）和糖化血红蛋白（HbA1c）水平（r=-0.228，P=0.036）呈负相关。FE-1 与空腹 C 肽（FCP）水平呈高度显著正相关（r=0.451，P<0.001）。此外，多元逻辑回归分析显示 FCP 是 PEI 的独立影响因素（OR=0.204，P=0.024，95%CI：0.051-0.813）。ROC 分析表明 FCP 水平对低 FE-1 具有预测价值（AUC=0.793，P<0.001），最佳截断值为 1.20ng/ml。
中国 T2DM 患者 PEI 患病率较高。FCP 可能是 T2DM 患者胰腺外分泌功能异常的潜在预测因子。临床实践中应评估 T2DM 患者的外分泌和内分泌功能。需要进一步的研究来阐明外分泌和内分泌胰腺之间的内在关联。
