摘要目的 探讨2型糖尿病患者接受持续皮下胰岛素输注(CSⅡ)治疗时CSⅡ对胰岛功能评估的影响.方法 2015年5至12月于中山大学附属第三医院内分泌与代谢病学科住院的125例2型糖尿病患者停用原降糖药物1d后检测空腹血糖、糖化血红蛋白、血脂、C肽(空腹、固定餐餐后30 min、2h),检测后接受CSⅡ治疗.血糖达标后在继续使用CSⅡ的情况下检测空腹、固定餐餐后30 min、2h C肽.检测当天晚上22时开始停止CSⅡ治疗,第2天重复前1天检测.结果 与CSⅡ治疗前比较,停CSⅡ后空腹[(0.41士0.16)比(0.35±0.20) nmol/L,P=0.015]、餐后30 min[(0.71±0.33)比(0.57±0.31) nmol/L,P=0.005]、餐后2 h[(1.37±0.75)比(0.84 ±0.54) nmol/L,P＜0.001]C肽水平均较治疗前各相应时间点C肽水平升高,而停CSⅡ前空腹[(0.23 ±0.13) nmol/L]、餐后30 min[(0.39 ±0.26) nmol/L]、餐后2 h[(0.67±0.50) nmol/L]C肽水平则低于治疗前相应时间点C肽水平(P ＜0.001,P＜0.001,P=0.023).经CSⅡ治疗后,停CSⅡ后各时间点的C肽水平较停CSⅡ前明显升高(均P＜0.001),各时间点C肽升高百分比分别为:141％(空腹)、127％(餐后1h)及219％(餐后2h).结论 为提高评估胰岛功能的准确性,使用CSⅡ治疗的2型糖尿病患者评估胰岛功能时最好停用CSⅡ.

abstractsObjective To evaluate the impact of continuous subcutaneous insulin infusion (CSⅡ) on β-cell function assessment.Methods One hundred and twenty-five patients with type 2 diabetes (T2DM) admitted to Third Affiliated Hospital of Sun Yat-sen University treated with CSⅡ were enrolled from May to December 2015.Blood samples were collected to measure their fasting blood glucose,haemoglobin A1c,blood lipids and plasma C peptide levels (fasting,30 min and 120 min after a mixed meal) on the next day of their admission before CSⅡ started.When patients achieved the target of fasting capillary glucose ≤ 7.0 mmol/L,C-peptide levels (0 min,30 min and 120 min after a mixed meal) were measured.Then CSⅡ were stopped at 10 pm with the same tests repeated on the next day.Results Compared with those measured before CSⅡ [0 min:(0.35 ± 0.20) nmol/L,30 min:(0.57 ± 0.31) nmol/L,120 min:(0.84 ±0.54) nmol/L],C-peptide levels after stopping CSⅡ at all time points [0 min:(0.41 ±0.16) nmol/L,30 min:(0.71 ±0.33) nmol/L,120 min:(1.37±0.75) nmol/L] increased (P=0.015,P=0.005,P ＜0.001) even glucose control was achieved,but significantly decreased immediately before CSⅡ was stopped [0 min:(0.23 ±0.13)nmol/L,30 min:(0.39 ±0.26) nmol/L,120 min:(0.67 ± 0.50) nmol/L] (P ＜ 0.001,P ＜ 0.001,P =0.023).The C-peptide after stopping CSⅡ increased to 141％ (0 min),127％ (30 min) and 219％ (120 min) respectively compared to those before stopping CSⅡ.Conclusion CSⅡ therapy should be stopped for accurate evaluation of β-cell function due to its "β-cell rest" effect in T2DM.