·胰岛素抵抗及其相关疾病·

　　林少达 段红艳 林楚佳 陈仲贤

　　作者单位：515041汕头大学医学院第一附属医院内分泌科

　　基金项目：广东省科技技术项目(2005B30701006)

　　【摘要】 目的 探讨肥胖及非肥胖2型糖尿病(T2DM)患者胰岛素抵抗(IR)与生长激素释放肽Ghrelin分泌的关系。 方法 肥胖T2DM患者26例(Ob+T2DM组)及非肥胖T2DM患者32例(NOb+T2DM组)，正常对照30名(NC组)行胰升血糖素—C-P释放试验，同步取血测定血浆Ghrelin和C-P。 结果 (1)Ob+T2DM组空腹Ghrelin水平低于NC组和NOb+T2DM组(P<0.05或P<0.01);Ob+T2DM组FC-P及胰岛素抵抗指数(HOMA2-IR)高于NC组和NOb+T2DM组(P<0.01或P<0.05)。静脉推注胰升血糖素后，NC组Ghrelin水平显著下降(P<0.01)，肥胖及非肥胖T2DM组Ghrelin水平无显著性改变。(2)Pearson相关分析显示空腹血浆Ghrelin水平分别与WC、BMI、体脂百分比、体脂重量呈负相关;多元回归分析显示腰围(WC)是Ghrelin水平的负性预测因子(回归方程Y=4.814-0.0265X)。(3)Ob+T2DM组中，空腹血浆Ghrelin水平分别与WC、BMI、体脂百分比、体脂重量、HOMA2-IR呈负相关。 结论 外源性给予胰升血糖素对T2DM患者Ghrelin抑制效应减弱;肥胖T2DM患者血浆Ghrelin水平较非肥胖患者明显降低，且与WC、BMI、体脂百分比、体脂重量、HOMA2-IR负相关;中心性肥胖T2DM患者血浆Ghrelin水平下降与IR有关。

　　【关键词】糖尿病，2型;Ghrelin;胰升血糖素;肥胖;胰岛素抵抗

　　doi:10.3969/j.issn.1006-6187.2011.04.001

　　Effects of exogenous glucagon on plasma ghrelin and obesity in type 2 diabetic patients

　　LIN Shao-da, DUAN Hong-yan, LIN Chu-jia, et al.

　　Department of Endocrinology,The First Affiliated Hospital of Shantou University Medical College, Shantou 515041，China

　　【Abstract】 Objective To study effects of exogenous glucagon on plasma ghrelin and obesity in type 2 diabetic patients. Methods The study subjects included the obese type 2 diabetics (Ob+T2DM, n=26), non-obese type 2 diabetics (NOb+T2DM, n=32) and normal control (NC, n=30). Plasma ghrelin and C-peptide were measured during glucagon stimulation test. Results The percent ghrelin inhibition induced by exogenous glucagon was lower in non-obese and obese T2DM (-0.1% and -4.1%, respectively with inter-subgroup difference at P<0.05) than in normal control (-13.2%)(all P<0.01). The plasma ghrelin was negatively correlated with waist circumference, BMI and body fat mass (γ value of -0.301 and P<0.01; γ=-0.25 and P<0.05; γ=-0.26 and P<0.05, respectively) in normal control group, negatively correlated with WC, BMI, BFM and HOMA-IR in obese type 2 diabetes group (γ=-0.31 and P<0.01; γ=-0.26 and P<0.05; γ=-0.30 and P<0.05; γ=0.30 and P<0.05 respectively). Fasting ghrelin was independently correlated with waist circumference. Conclusions Fasting ghrelin level in obese T2DM group is lower than in non-obese T2DM group,and is correlated with waistline,body mass index,body fat percentage,body fat weight,HOMA2-IR.The decreasing of fasting ghrelin in central obese diabetic patients may be related with insulin resistance.

　　【Key words】Diabetes mellitus, type 2; Ghrelin; Glucagon; Obesity; Insulin resistance