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目的探讨精氨酸刺激试验能否用于评价胰岛β细胞储备功能及其判断标准。方法分别检测225人空腹及盐酸精氨酸刺激后2、4、6 min时血糖(PG)、真胰岛素(TI)、C肽(CP)水平的变化,其中正常糖耐量组(NGT)39名、糖耐量受损组(IGT)29例、1型糖尿病组(T1DM)11例,新诊断2型糖尿病组(NT2DM)43例和原诊断2型糖尿病组(PT2DM)103例。结果(1)NGT组空腹TI/PG显著高于IGT组(P<0.05),但两组的空腹CP/PG差异无统计学意义(P>0.05)。空腹CP/PG在T1DM、NT2DM、PT2DM组显著低于NGT、IGT组(均P<0.01),并且PT2DM组显著低于NT2DM组(P<0.01)。(2)精氨酸刺激后T1DM组无快速TI、CP分泌。其余各组在刺激后TI/PG、CP/PG除IGT组与NGT组差异无统计学意义(P>0.05)外,NT2DM、TP2DM组均显著低于NGT、IGT组(均P<0.01),并且2 min时PT2DM组亦显著低于NT2DM组(均P<0.01)。(3)精氨酸刺激后TI/PG、CP/PG的增值及曲线下面积在NGT、NT2DM、PT2DM三组间差异有统计学意义(均P<0.01)。结论(1)精氨酸刺激试验可用于判别和评估不同糖代谢状态人群胰岛β细胞功能,尤其是DM人群β细胞功能的判别。(2)精氨酸刺激后TI/PG值及其峰值/空腹值、TI/PG的增值和曲线下面积均可能作为评价β细胞功能异常的指标,其中以TI/PG的增值和曲线下面积为佳。
Objective To investigate whether arginine stimulation test can be used to evaluate the function of pancreatic β-cell reserve and its criteria. Methods The levels of blood glucose (PG), true insulin (TI) and C peptide (CP) in 225 individuals at 2,4,6 min after fasting and arginine hydrochloride were measured respectively. The normal glucose tolerance group (NGT) , 29 patients with impaired glucose tolerance (IGT), 11 patients with type 1 diabetes mellitus (T1DM), 43 newly diagnosed type 2 diabetic patients (NT2DM) and 103 patients with type 2 diabetes mellitus (PT2DM). Results (1) The fasting TI / PG in NGT group was significantly higher than that in IGT group (P <0.05), but there was no significant difference in fasting CP / PG between two groups (P> 0.05). Fasting CP / PG in T1DM, NT2DM and PT2DM groups was significantly lower than that in NGT and IGT groups (all P <0.01), and PT2DM group was significantly lower than NT2DM group (P <0.01). (2) There was no rapid TI and CP secretion in T1DM group after arginine stimulation. The levels of TI / PG and CP / PG in the remaining groups were significantly lower than those in NGT and IGT groups (P <0.01) except IGT group and NGT group (P> 0.05) And PT2DM group was also significantly lower than NT2DM group 2 min (all P <0.01). (3) The values of TI / PG, CP / PG after arginine stimulation and the area under the curve were significantly different between NGT, NT2DM and PT2DM groups (all P <0.01). Conclusion (1) Arginine stimulation test can be used to determine and assess the β-cell function in different groups of glucose metabolism, especially β-cell function in DM population. (2) The value of TI / PG and its peak value / fasting value, the increment of TI / PG and the area under the curve of arginine stimulation may be used as indicators to evaluate the abnormality of β cell function. The value of TI / PG and the area under the curve Better.