·糖尿病临床研究·

　　王文君 徐春 牛玉坚 杨雪梅 程海梅 沈中阳

　　基金项目：武警总医院科研基金

　　作者单位：100039北京，武警总医院内分泌科(王文君、徐春、程海梅、杨雪梅)，肝移植中心(牛玉坚、沈中阳)

　　【摘要】目的研究肝移植受者移植术后的胰岛素分泌特点。方法根据75g葡萄糖耐量试验结果将60例肝移植受者分成为移植后糖耐量正常(PTNGT)组(n=24)、移植后糖耐量异常组(PTIGT, n=14)和移植后糖尿病组(PTDM, n=22)。采集PTNGT组、PTIGT组、PTDM组及正常组(NGT)的葡萄糖耐量试验及胰岛素释放试验结果。采用稳态模型评估法评估β细胞功能指数(HOMA-β)和胰岛素抵抗指数(HOMA-IR)。结果与NGT组相比，PTNGT组出现胰岛素分泌高峰延迟，并且PTNGT组的HBCI明显升高。PTNGT组、PTIGT组及PTDM组的HOMA-IR 均明显高于NGT组(P<0.05)，PTIGT组及PTDM组的HOMA-β明显低于NGT组(P<0.05)。结论PTDM患者同时存在胰岛素抵抗及β细胞功能减退，肝移植后NGT患者已存在明显的胰岛素抵抗和代偿性胰岛素分泌增加和峰对后移，应对其采取相应干预措施。

　　【关键词】胰岛素分泌;肝移植;器官移植术后糖尿病;胰岛素抵抗;β细胞功能

　　doi:10.3969/j.issn.1006-6187.2012.02.014

　　Changes of insulin sensitivity and secretion ability in patients with post-liver transplantation diabetes mellitus

　　WANG Wen-jun，XU Chun，NIU Yu-jian，et al.Department of Endocrinology, The General Hospital of Chinese Armed Police Forces, Beijing 100039, China

　　【Abstract】ObjectiveTo study the characteristics of insulin secretion of post-liver transplantation diabetes mellitus. Methods60 liver transplantation recipients were divided into three groups according to the results of 75g oral glucose tolerance test(OGTT) : post-transplantation normal glucose tolerance(PTNGT)(n=24), post-transplantation impaired glucose tolerance (PTIGT)(n=14), and post-transplantation diabetes mellitus (PTDM)(n=22). Insulin releasing test was performed in all the three groups ,as well as in normal glucose tolerance patients without liver transplantation(NGT)group(n=20).Insulin resistance and β-cell function were assessed by homeostasis model assessment(HOMA) method. ResultsHomeostasis model assessment-insulin secretion index (HOMA-β) in PTNGT group was significantly higher than in NGT group(P<0.05). Insulin secretion peak was significantly delayed in the PTNGT versus NGT group. HOMA-β was lower in either PTIGT group or PTDM group than in NGT and PT-NGT group (P<0.05 respectively ). Homeostasis model assessment-insulin resistance(HOMA-IR) in PTNGT, PTIGT and PTDM group were higher than in the NGT group (P<0.05 respectively). ConclusionBoth insulin resistance and β-cell dysfunction occur in PTDM patients. Insulin resistance and compensative insulin secretion increase have obviously existed in patients with normal plasma glucose after liver transplantation, which should be treated appropriately.

　　【Key words】Insulin secretion; Liver transplantation; Post-transplantation diabetes mellitus; Insulin resistance; Islet β-cell function