Mechanisms of glucose intolerance in cystic fibrosis
Mechanisms of glucose intolerance in cystic fibrosis
复制标题
DOI：
10.1111/j.1464-5491.2009.02738.x
复制
发表时间：
2009-06-01
影响因子：
3.5
通讯作者：
Walshaw, M.
中科院分区：
文献类型：
--
作者：
Mohan, K.;Miller, H.;Walshaw, M.
尽管囊性纤维化相关糖尿病（CFRD）是囊性纤维化（CF）的不良预后因素，其特征是胰岛素减少，但胰岛素抵抗的作用尚不清楚。我们采用前瞻性研究设计，测量了胰岛素抵抗、胰腺 β 细胞功能，并将血糖状态与临床参数相关联。对 60 名稳定的成年 CF 患者进行了口服葡萄糖耐量试验。使用稳态模型评估 (HOMA2)、Stumvoll 和口服葡萄糖胰岛素敏感性 (OGIS) 指数测量胰岛素敏感性和 β 细胞功能。42 名 (70%) 糖耐量正常 (NGT)，10 名 (17%) 糖耐量受损 (IGT) 和 8 名 (13%) CFRD。三组间胰岛素敏感性无差异（HOMA2：NGT 280、IGT 250、CFRD 339，P = 0.42；Stumvoll：NGT 0.128、IGT 0.126、CFRD 0.129，P = 0.76；OGIS：NGT 515、IGT 472、CFRD 472，P = 0.12）。 CFRD 中胰腺 β 细胞功能（CFRD 50% 对比 NGT 67%；P < 0.05）和第一相胰岛素分泌降低（250 对比 NGT 509；P = 0.004）。第一相胰岛素分泌与 1 小时 (r = -0.74; P < 0.0001) 和 2 小时葡萄糖水平 (r = -0.34; P < 0.05) 呈负相关。体重指数或肺功能不良（1 秒用力呼气量：CFRD 54% 对比 NGT 65%；P = 0.43）没有差异。然而，CFRD 组的入院次数较多（每位患者每年 3 例，NGT 1 例；P < 0.05）。CFRD 的特点是胰岛素分泌的定性和定量缺陷，但不是胰岛素抵抗，并且与肺部病情加重入院率增加相关。
Although cystic fibrosis-related diabetes (CFRD), a poor prognostic factor in cystic fibrosis (CF), is characterized by insulinopenia, the role of insulin resistance is unclear. Using a prospective study design, we measured insulin resistance, pancreatic beta-cell function and correlated glycaemic status with clinical parameters.Oral glucose tolerance test was performed in 60 stable adult CF patients. Insulin sensitivity and beta-cell function were measured using the homeostatic model assessment (HOMA2), Stumvoll and oral glucose insulin sensitivity (OGIS) indices.Forty-two (70%) had normal glucose tolerance (NGT), 10 (17%) impaired glucose tolerance (IGT) and eight (13%) CFRD. There was no difference in insulin sensitivity among the three groups (HOMA2: NGT 280, IGT 250, CFRD 339, P = 0.42; Stumvoll: NGT 0.128, IGT 0.126, CFRD 0.129, P = 0.76; and OGIS: NGT 515, IGT 472, CFRD 472, P = 0.12). Pancreatic beta-cell function (CFRD 50% vs. NGT 67%; P < 0.05) and first-phase insulin secretion were reduced in CFRD (250 vs. NGT 509; P = 0.004). First-phase insulin secretion was inversely correlated with 1-h (r = -0.74; P < 0.0001) and 2-h glucose levels (r = -0.34; P < 0.05). There was no difference in body mass index or poor lung function (forced expiratory volume in 1 s: CFRD 54% vs. NGT 65%; P = 0.43). However, there were more hospital admissions in the CFRD group (three vs. NGT one per patient per year; P < 0.05).CFRD is characterized by qualitative and quantitative defects in insulin secretion, but not insulin resistance, and is associated with increased hospital admissions for pulmonary exacerbations.