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目的 以那格列奈 (NG) 口服葡萄糖耐量试验 (OGTT)方法评估LADA患者及其一级亲属(FDR)胰岛 β细胞功能。 方法 9例正常人 1周内先后行NG OGTT、精氨酸刺激试验和普通OGTT ,测定各时点的胰岛素和血糖水平。观察NG OGTT中胰岛素净增值与血糖净增值的比值 (ΔI/ΔG)和精氨酸刺激试验中急性期胰岛素释放 (AIR)的相关性 ,比较NG OGTT和普通OGTT的差异和关联。 10例FDR行NG OGTT和普通OGTT ,LADA和 2型糖尿病 (DM)患者各 9例仅行NG OGTT ,比较 4组研究对象在NG OGTT中的早期相胰岛素释放和胰岛 β细胞储备功能 ,并用HOMA公式评估胰岛素抵抗。 结果 (1)NG OGTT中胰岛素释放速率 (IRR)最高点为糖负荷后 3 0min ,且该时点的ΔI3 0 /ΔG3 0 与精氨酸刺激试验的AIR呈正相关 (Rs =0 .674,P <0 .0 5 ) ;NG OGTT中各时点胰岛素曲线下面积和胰岛素释放倍增值均高于普通OGTT(均P <0 .0 1)。 (2 )LADAFDR在NG OGTT中ΔI3 0 /ΔG3 0 (2 3 .0± 13 .2 )mU/mmol和 3 0min处IRR (1.3± 0 .8)mU·L-1·min-1均低于正常 (P <0 .0 5 ) ,而HOMA IR指数高于正常 (2 .2± 0 .7vs 1.5± 0 .7,P <0 .0 5 )。 (3 )LADA和 2型DM患者的HOMA IR指数分别为 (2 .9± 0 .9和 5 .0± 3 .4) ,均高于正常 (1.5± 0 .7) (2型DM >LADA >正常
Objective To evaluate the islet β-cell function in LADA patients and their first degree relatives (FDR) with oral glucose tolerance test (OGTT). Methods Nine healthy volunteers conducted NG OGTT, arginine stimulation test and ordinary OGTT in one week. The levels of insulin and blood glucose were determined at each time point. The correlation between NG OGTT and normal OGTT was observed by observing the correlation between net insulin and net glucose (ΔI / ΔG) in NG OGTT and acute phase insulin release (AIR) in arginine stimulation test. NGOGTT was performed in 9 of 10 patients with NG OGTT, normal OGTT, LADA and type 2 diabetes mellitus (DM) in 10 FDR patients. The early phase insulin release and islet β-cell reserve function in NG OGTT were compared among 4 groups. HOMA The formula evaluates insulin resistance. Results (1) The highest IRR of NG OGTT was 30 min after the glucose load, and the ΔI3 0 / ΔG3 0 at this time was positively correlated with the AIR of arginine stimulation test (Rs = 0.674, P <0. 05). The area under the curve of insulin and the release of insulin in each point of NG OGTT were higher than those of normal OGTT (all P <0.01). (2) The LADAFDR in IRGTT was lower than that of ΔI3 0 / ΔG3 0 (23.0 ± 13.2) mU / mmol and 30 min (1.3 ± 0.8) mU · L-1 · min-1 Normal (P <0.05), while HOMA IR index was higher than normal (2.2 ± 0.7 vs 1.5 ± 0.7, P <0.05). (3) The HOMA IR index of patients with LADA and type 2 diabetes mellitus were (2.9 ± 0.9) and (5.0 ± 3.4) cases, respectively, which were higher than those of normal (1.5 ± 0.7) (DM2> LADA > Normal