摘要
目的 探讨短期持续皮下胰岛素输注（CSII）对新诊断2型糖尿病（T2DM）患者β细胞功能、胰岛素抵抗（IR）和血管内皮细胞损伤的作用及机制.方法 对10例新诊断T2DM患者进行2周CSII.CSII前后,依次进行静脉糖耐量试验（IVGTT）和高胰岛素正葡萄糖钳夹试验.用血清可溶性E选择素（sE-selectin）评价血管内皮细胞损伤.用血清超敏C反应蛋白（hsCRP）和可溶性CD14（sCD14）评价机体的炎症状态.结果 （1）与治疗前比较,CSII后IVGTT各时点血糖值、血糖曲线下面积、糖化血红蛋白、胆固醇和LDL-C水平下降（P〈0.05或〈0.01）.（2）与治疗前比较,CSII后IVGTT各时点（空腹胰岛素除外）胰岛素增加、胰岛素曲线下面积增大、急性胰岛素分泌增加（P〈0.05或〈0.01）.（3）与治疗前比较,CSII后葡萄糖输注率[由（3.46±1.66）mg·kg^-1·min^-1升高到（7.14±2.37）mg·kg^-1·min^-1]和稳态模型评估的基础胰岛β细胞功能（HOMA-β）升高,HOMA胰岛素抵抗指数（HOMA-IR）下降（P〈0.05或0.01）.（4）与治疗前比较,CSII后患者血清sE-selectin、sCD14和hsCRP下降（除hsCRP外,P〈0.01）.结论 短期胰岛素强化治疗有利于恢复新诊断T2DM患者胰岛功能、减轻IR、修复血管内皮细胞损伤和改善糖、脂代谢,其机制可能与机体炎症状态的减轻有关.
Objectives To explore the effect of transient continuous subcutaneous insulin infusion （CSII） on β cell function, insulin resistance and vascular endothelial injury in newly diagnosed type 2 diabetic patients and its potential mechanism. Methods Ten patients with newly diagnosed type 2 diabetes mellitus （T2DM） accepted CSII for two weeks. Intravenous glucose tolerance test （IVGTT） and hypefinsulinemia euglycemia clamp test were performed before and after CSII. Serum soluble E-selectin （ sEselectin） was used to evaluate the injury of vascular endothelial cell, while serum high sensitivity C reactive protein （hsCRP） and soluble CDI4 （ sCD14 ） were both used to assess inflammatory condition. Results （ 1 ） Compared with those before treatment, the blood glucose levels of IvGTT, the area under the curve of the blood glucose, glycosylated hemoglobin, TC and LDL-C in the patients were decreased after CSII （P 〈0. 05 or 0. 01 ）. （2） Compared with those before treatment, the insulin levels of IVGTT （except the fasting insulin） , the area under the curve of insulin and acute insulin response were all increased after CSII （P 〈 0. 05 or 0. 01 ）. （3） Compared with that before treatment, the glucose infusion ratio in the clamp test [（3.46 ± 1.66） mg·kg^-1·min^-1 increased to （7. 14±2.37） mg ·kg^-1·min^-1]and HOMA-β elevated, while HOMA-IR declined （P 〈0. 05 or 0. 01 in all）. （4） Compared with those before treatment, the levels of serum sE-selectin, sCD14 and hsCRP were decreased （P 〈 0. 01, except for hsCRP） . Conclusion Transient intensive insulin therapy in patients with newly diagnosed T2DM is useful to restore β eell function, attenuate insulin resistance, repair vascular endothelial injury and improve the disorder of blood sugar and lipid. The mechanism may be related with the inhibition of inflammation in patients.
出处
《中华内科杂志》
CAS
CSCD
北大核心
2010年第5期405-409,共5页
Chinese Journal of Internal Medicine
基金
中南大学代谢综合征研究中心项目（DY-2008-02-02）
关键词
糖尿病
2型
胰岛素分泌细胞
胰岛素抗药性
内皮细胞
持续皮下胰岛素输注
短期
Diabetes mellitus,type 2
Insulin-secreting cells
Insulin resistance
Endothelial cells
Continuous subcutaneous insulin infusion, transient
作者简介
通信作者：周智广，Email：zhouzg@hotmail．com
