FASTING PLASMA C-PEPTIDE, GLUCAGON STIMULATED PLASMA C-PEPTIDE, AND URINARY C-PEPTIDE IN RELATION TO CLINICAL TYPE OF DIABETES
FASTING PLASMA C-PEPTIDE, GLUCAGON STIMULATED PLASMA C-PEPTIDE, AND URINARY C-PEPTIDE IN RELATION TO CLINICAL TYPE OF DIABETES
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DOI：
10.1007/bf00265547
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发表时间：
1989-05-01
期刊：
影响因子：
8.2
通讯作者：
FROLAND, A
中科院分区：
文献类型：
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作者：
GJESSING, HJ;MATZEN, LE;FROLAND, A
许多 2 型（非胰岛素依赖型）糖尿病患者接受胰岛素治疗以控制高血糖。我们在 132 名接受胰岛素治疗的糖尿病受试者中研究了空腹血浆 C 肽、胰高血糖素刺激血浆 C 肽和 24 小时尿 C 肽与糖尿病临床类型的关系。患者在临床上被分类为 1 型（胰岛素依赖型）糖尿病受试者，且至少满足以下标准中的两项：1）显着酮尿，2）诊断后一年内开始胰岛素治疗，3）诊断年龄≤。 40岁，4)体重低于同年龄同性别理想体重的110%。 80 名患者被归类为 1 型糖尿病受试者，52 名患者被归类为 2 型糖尿病受试者。然后对患者进行第二次分类，分为 6 个 C 肽类别。 I 类由没有胰岛 B 细胞功能的患者组成。 II-VI 类保留了胰岛 B 细胞功能，并根据 20%、40%、60% 和 80% C 肽百分位数进行分离。通过计算每个 C 肽类别中临床 1 型和 2 型糖尿病的患病率来比较这两种类型的患者。本次分析显示，空腹血浆C肽值<0.20mmol/l、胰高血糖素刺激血浆C肽值<0.32nmol/l、尿C肽值<3.1nmol/l、或<0.54nmol/mmol肌酐/24h、或<5.4nmol/24h的患者主要为1型糖尿病患者；而C肽水平高于这些值的患者主要是2型。在这些限制下，作为2型糖尿病指标的阳性测试的预测值的百分比如下：空腹肽83%，刺激C肽86%，尿C肽以nmol/l表示为76%，以nmol/mmol肌酐/24小时表示为79%，以nmol/24小时表示为78%。同样，阴性测试作为 1 型糖尿病指标的百分比预测值如下：空腹 C 肽 86%，刺激 C 肽 88%，尿 C 肽以 nmol/l 表示，为 79%，如 nmol .cntdot。 mmol 肌酐.cntdot。 24 小时 81%，nmol/24 小时 80%。如果排除未检测到 C 肽的患者，阴性检测的预测值如下：空腹 C 肽 81%，刺激 C 肽 88%，尿 C 肽以 nmol/l 表示 61%，以 nmol/mmol 肌酐/24 小时表示 69%，以 nmol/24 小时表示 64%。总之，胰高血糖素后 C 肽可以很好地区分胰岛素治疗的糖尿病中的 1 型和 2 型糖尿病，而 24 小时尿 C 肽则可以不太敏感地区分糖尿病的临床类型。
Many patients with Type 2 (non-insulin-dependent) diabetes mellitus are treated with insulin in order to control hyperglycaemia. We studied fasting plasma C-peptide, glucagon stimulated plasma C-peptide, and 24 h urinary C-peptide in relation to clinical type of diabetes in 132 insulin treated diabetic subjects. Patients were classified clinically as Type 1 (insulin-dependent) diabetic subjects in the presence of at least two of the following criteria: 1) significant ketonuria, 2) insulin treatment started within one year after diagnosis, 3) age of diagnosis .ltoreq. 40 years, and 4) weight below 110% of ideal weight of the same age and sex. Eighty patients were classified as Type 1 and 52 as Type 2 diabetic subjects. A second classification of patients into 6 C-peptide classes was then performed. Class I consisted of patients without islet B-cell function. Class II-VI had preserved islet B-cell function and were separated according to the 20%, 40%, 60% and 80% C-peptide percentiles. The two classifications of patients were compared by calculating the prevalence of clinical Type 1 and Type 2 diabetes in each of the C-peptide classes. This analysis showed that patients with a fasting plasma C-peptide value < 0.20 mmol/l, a glucagon stimulated plasma C-peptide value < 0.32 nmol/l, and a urinary C-pepitde value < 3.1 nmol/l, or < 0.54 nmol/mmol creatinine/24 h, or < 5.4 nmol/24 h mainly were Type 1 diabetic patients; while patients with C-peptide levels above these values mainly were Type 2. At these limits the percentage, predictive value of positive tests as indicators of Type 2 diabetes were as follows: fasting-peptide 83%, stimulated C-peptide 86%, and urinary C-peptide expressed as nmol/l 76%, as nmol/mmol creatinine/24 h 79%, and as nmol/24 h 78%. Similarly, the percentage predictive value of negative tests as indicators of Type 1 diabetes were as follows: fasting C-peptide 86%, stimulated C-peptide 88%, and urinary C-peptide expressed as nmol/l 79%, as nmol .cntdot. mmol creatinine .cntdot. 24 h 81%, and as nmol/24h 80%. If patients without detectable C-peptide were excluded, the predictive value of negative tests were as follows: fasting C-peptide 81%, stimulated C-peptide 88%, urinary C-peptide expressed as nmol/l 61%, as nmol/mmol creatinine/24 h 69%, and as nmol/24 h 64%. In conclusion, post glucagon C-peptide gives a good distinction between Type 1 and Type 2 diabetes mellitus in insulin treated diabetes while 24 h urinary C-peptide gives a less sensitive distinction between the clinical types of diabetes.