·糖尿病的胰岛素治疗·

　　熊静 莫朝晖 谢艳红 胡平安 刘敏 何红晖

　　作者单位：410013长沙，中南大学湘雅三医院内分泌科

　　通讯作者：莫朝晖，E-mail: mzh1964@126.com

　　【摘要】目的观察新诊断的T2DM患者短期胰岛素泵强化血糖控制后肠促胰岛素的变化及其与β细胞功能变化的关系。方法选择21例新诊断的T2DM患者接受为期14 d的持续皮下胰岛素注射，于治疗前和治疗14 d后分别行75g OGTT，检测0min、30min、120min静脉血糖、胰岛素、C肽、胰升血糖素样肽1(GLP-1)、葡萄糖依赖性促胰岛素分泌多肽(GIP)、胰升血糖素水平。并检测17例血糖正常对照者GLP-1水平。结果糖尿病患者治疗前0min、30min、120min 血GLP-1水平及GLP-1曲线下面积(0-30-120min AUC)较正常对照者均显著降低(P<0.05);强化治疗后0min、30min、120min GLP-1水平及曲线下面积较治疗前均明显升高(P<0.01);而GIP水平及曲线下面积无明显变化(P>0.05)，胰升血糖素则有明显下降(P<0.05)。同时HOMA-β指数及△INS30/△G30、△INS120/△G120明显升高(P<0.05)，HOMA-IR指数显著降低。结论新诊断T2DM患者经短期胰岛素强化治疗后，GLP-1水平升高，胰升血糖素水平降低可能与胰岛β细胞功能与胰岛素抵抗得到改善有关。

　　【关键词】糖尿病，2型; 持续皮下胰岛素注射; β细胞功能; 肠促胰岛素

　　doi:10.3969/j.issn.1006-6187.2012.02.010

　　Effects of short-term intensive insulin therapy on the levels of incretins in newly diagnosed type 2 diabetesXIONG Jing，MO ZHAO-hui，XIE Yan-hong，et al. Department of Endocrinology，The Third Xiangya Hospital，Central South University，Changsha 410013，China

　　Corresponding outhor: MO ZHAO-hui, E-mail: mzh1964@126.com

　　【Abstract】ObjectiveTo observe the effect of short-term intensive insulin therapy on the levels of incretins and islet β-cell function in the newly diagnosed type 2 diabetic patients. MethodsTwenty-one newly diagnosed type 2 diabetic patients were treated with continuous subcutaneous insulin infusion(CSII) for 14 days.Before and after intensive insulin therapy，oral glucose tolerance test(OGTT)and insulin release test(IRT) were performed. The levels of plasma glucose，insulin，C-peptide，glucagon like peptide-1(GLP-1)，glucose-dependent insulinotropic polypeptide(GIP) and glucagon were examined in 0min，30min，120min respectively. The plasma GLP-1 levels of 17 controls with normal plasma glucose were also detected. ResultsBefore intensive insulin therapy，the levels of plasma GLP-1 and the mean area under the curve(AUC) of GLP-1 were lower obviously in newly diagnosed type 2 diabetic patients than in the controls. After versus before intensive insulin therapy，the levels of plasma GLP-1 and the AUC of GLP-1 were increased markedly(P<0.01)，while plasma glucagon levels were decreased(P<0.05).The homeostatic model assessment of the insulin secretion index(HOMA-beta)，△INS30/△G30，△INS120/△G120 were increased significantly(P<0.05)，while the homeostatic model assessment of insulin resistance index(HOMA-IR)decreased markedly after treatment versus before. ConclusionsThe short-term intensive insulin therapy could increase plasma GLP-1 levels and reduce plasma glucagon levels in newly diagnosed type 2 diabetic patients，which might be related to the improvement of islet β-cell function and insulin resistance.

　　【Key words】Diabetes mellitus，type 2;Continuous subcutaneous insulin infusion;β-cell function;incretins