Glucose tolerance and insulin secretion, morbidity, and death in patients with cystic fibrosis
Glucose tolerance and insulin secretion, morbidity, and death in patients with cystic fibrosis
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DOI：
10.1016/j.jpeds.2007.09.025
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发表时间：
2008-04-01
影响因子：
5.1
通讯作者：
Robert, Jean-Jacques
中科院分区：
文献类型：
--
作者：
Bismuth, Elise;Laborde, Kathleen;Robert, Jean-Jacques
目的描述囊性纤维化（CF）相关的糖尿病的历史、机制和后果，从儿童期到成年早期。研究设计通过口服葡萄糖耐量试验期间的血浆胰岛素/葡萄糖比率（总曲线下面积和Δ I30- 0 min/G（30 min））来估计胰腺β细胞功能。采用稳态模型评估法[HOMA]%B）和HOMA%S指数对237例CF患儿（男109例，女128例）进行胰岛素敏感性测定。结果10年、15年、20年、30年患者糖耐量异常发生率分别为20%、50%、75%、82%;对于糖尿病，15年时>20%，20年时45%，30年时70%;对于胰岛素治疗，20年时30%，30年时40%。早期损伤与较低的存活率和较高的肺移植率相关。曲线下面积（葡萄糖）与体重指数和身高的下降相关。在所有糖尿病胰岛素分泌评估中，早期胰岛素分泌减少（Δ I30- 0 min/G（30 min））与糖耐量受损相关。HOMA%S在组间无差异。炎症增加与胰岛素抵抗和葡萄糖耐量受损相关。结论CF相关的糖尿病，主要是因为β细胞缺乏，是经常在生命的早期，并与受损的营养状态和生长。终末呼吸衰竭和死亡率增加。
Objectives To describe the history, mechanisms, and consequences of cystic fibrosis (CF)-related diabetes, from childhood to early adulthood.Study design Pancreatic beta-cell function was estimated from the plasma insulin/glucose ratios during oral glucose tolerance test (total area under the curve and Delta I30-0min/G(30min). homeostasis model assessment [HOMA]%B), insulin sensitivity with the HOMA%S index, in 237 children with CF (109 boys, 128 girls). Progression of glucose metabolism abnormalities was evaluated by analysis for interval censored data; rates of pulmonary transplantation and death by Kaplan-Meier analysis.Results Impaired glucose tolerance was found in 20% of patients at 10 years, 50% at 15 years, 75% at 20 years, 82% at 30 years; for diabetes, >20% at 15 year, 45% at 20 years, 70% at 30 years; for insulin treatment, 30% at 20 years, 40% at 30 years. Early impairment was associated with lower survival rates and higher rates of lung transplantation. The area under the curve(glucose) correlated with decreased body mass index and height. Decrease in early insulin secretion (Delta I30-0min/G(30min)) was associated with impaired glucose tolerance, in all estimates of insulin secretion with diabetes. HOMA%S did not differ between the groups. Increased inflammation correlated with insulin resistance and impaired glucose tolerance.Conclusions CF-related diabetes, mainly because of beta-cell deficiency, is frequent early in life and associated with impaired nutritional state and growth. increased rates of terminal respiratory failure, and death.