肝脏清除胰岛素减少相关的糖代谢衰老

Senescence of glycometabolism with reduced hepatic clearance of insulin

摘要:

目的 探索葡糖糖代谢（GM）的衰老现象。方法 纳入2007年3月至2009年10月住解放军第458医院两内科综合病区的空腹受检病例383例及行口服葡萄糖耐量试验（OGTT）的受检病例87例。根据两因素析因方案, 将空腹受试者按GM因素分为2型糖尿病组（T2D）、糖尿病前期组（PD）和正常血糖（EG）组, 按年龄分为老年组、中年组、青年组; 同时将行OGTT者按GM因素分为T2D组、非糖尿病组, 按年龄分为老年组、非老年组。检测受试者血糖、胰岛素（Ins）、C肽水平。结果 空腹状态下T2D、PD和EG组中, T2D组血糖最高, PD组Ins和C肽水平最高（P＜0.05）; 老、中、青3组中, 中年组血糖和C肽水平最高, 老年组Ins水平最高（P＜0.05）; 观察指标均存在GM与年龄两因素的交互作用（P＜0.05）。OGTT刺激后, T2D组Ins早相分泌不足（P＜0.01）; OGTT后1, 2, 3h老年组血糖低于非老年组, Ins和C肽水平老年组高于非老年组（P＜0.05）。结论 GM存在衰老现象, 即随年龄增加, 空腹Ins升高, GM与年龄两因素存在交互作用; 老年人肝脏清除Ins减少, 致刺激性分泌的Ins入血增多。

Abstract:

Objective To study the senescence of glycometabolism(GM) with reduced hepatic clearance of insulin. Methods Totally 383 patients admitted in Chinese PLA 458th Hospital between March 2007 and October 2009 were recruited in the study, including 383 fasting cases and 87 oral glucose tolerance test(OGTT) cases. According to method of two factorial experiment, fasting patients were divided into type 2 diabetes(T2D), pre-diabetes(PD) and euglycemia group by GM; aged, middle and young group by age. Meanwhile, OGTT patients were divided into T2D and non-diabetes group by GM; aged and non-aged group by age. Biochemical assays including plasma glucose(PG), insulin(Ins) and C-peptide(C) were carried out for all patients. The quantitative data of assays were analyzed by SPSS13.0 software with ANOVA or S-N-K. Results In fasting state, patients of T2D group had highest level of plasma glucose, and PD group had the highest Ins and C-peptide levels (P＜0.05); middle age group had highest PG and C-peptide levels (P＜0.05), and the highest Ins was found in aged group; there was interaction of assays between GM and age (P＜0.05). With OGTT stimulation, early phase secretion of Ins was deficient in T2D group(P＜0.01); PG in aged group was lower than that in non-aged group, but Ins and C-peptide in aged group exceeded that in non-aged group 1-3 h after OGTT(P＜0.05). Conclusion There is senescence on GM: fasting Ins increases with age, and there is interaction between GM and senescence. More Ins released in blood is observed due to the reduced hepatic clearance in aged patients.