口服谷氨酰胺对2型糖尿病患者血浆胰高血糖素样肽-1分泌的影响-东南大学学报医学版

口服谷氨酰胺对2型糖尿病患者血浆胰高血糖素样肽-1分泌的影响

作者：成玮¹ 邓云¹ 黄勤² 姚晓阳¹ 金文琪¹ 李丽华¹ 吴铱达¹ 彭嵘¹ 贝鹏剑¹ 陈荔萍¹ 汤似韫¹ 王华¹

单位：1. 上海市第七人民医院内分泌科, 上海 200370;
2. 长海医院内分泌科, 上海 200433

分类号：R587.1

出版年·卷·期（页码）：2015·34·第二期（196-202）

摘要：

目的:观察口服谷氨酰胺对2型糖尿病患者血浆胰高血糖素样肽-1(GLP-1)分泌的影响.方法:收集10例糖耐量异常者、10例病程< 1年的2型糖尿病患者、10例病程≥1年而< 5年的2型糖尿病患者、10例病程≥5而< 10年的2型糖尿病患者、10例病程≥10年的2型糖尿病患者以及10例非肥胖健康个体作为研究对象.间隔1个月先后口服75 g葡萄糖及30 g谷氨酰胺,在服药前(0 min)及口服药物后30、60、90和120 min分别留血,检测血浆GLP-1、胰岛素以及血糖水平的变化.结果:口服75 g葡萄糖后,健康人及不同病程2型糖尿病患者的血浆GLP-1水平均升高,健康人的GLP-1分泌高峰在30 min(6.167 ng·ml^-1),糖耐量异常者、病程< 1年、病程≥1年而< 5年、病程≥5年而< 10年的2型糖尿病患者GLP-1的分泌高峰也在30 min(分别为4.195、3.706、3.794、3.000 ng·ml^-1),病程≥10年的2型糖尿病患者GLP-1的分泌高峰在60 min(3.923 ng·ml^-1).口服30 g谷氨酰胺后,所有的受试者的血浆GLP-1的水平也均升高,健康人、糖耐量异常者以及病程< 1年的2型糖尿病患者的GLP-1分泌高峰均在30 min(分别为5.488、3.719、3.718 ng·ml^-1),病程≥1年而< 5年、病程≥5年而< 10年以及病程≥10年的2型糖尿病患者GLP-1分泌高峰在60 min(分别为3.667、2.399、2.368 ng·ml^-1).结论:不同病程的2型糖尿病患者存在不同程度的GLP-1分泌缺陷,口服葡萄糖刺激的GLP-1分泌峰值随糖尿病病程的增加呈下降趋势.口服30 g谷氨酰胺可以促进不同病程的2型糖尿病患者血浆GLP-1的分泌,并且不会影响2型糖尿病患者的血糖水平.谷氨酰胺通过促进2型糖尿病患者GLP-1的分泌,可能可以在2型糖尿病患者的血糖控制中发挥作用.

Objective: To observe the effect of oral glutamine on the secretion of plasma GLP-1 in patients with type 2 diabetes(T2DM). Methods:10 cases of patients with impaired glucose tolerance(IGT), 10 cases of patients with T2DM(disease course<1 year), 10 cases of patients with T2DM(1 year≤disease course< 5 years), 10 cases of T2DM(5 years≤disease course< 10 years) and 10 cases of T2DM(disease course≥10 years) were recruited and 10 cases of non-obese healthy individuals were selected as the control group. Oral glucose(75 g) and glutamine(30 g)were administered on 2 separated days with one month interval, and the plasma GLP-1, GIP, insulin, glucagon and glucose levels were measured at baseline (0 min) and 30 min, 60 min, 90 min and 120 min after oral drugs. Results: After oral 75 g glucose, the plasma GLP-1 levels were increased in healthy people and patients with different course of T2DM, the GLP-1 secretion peak was at 30 min(6.167 ng·ml^-1) in healthy controls, which was also at 30 min(4.195 ng·ml^-1, 3.706 ng·ml^-1, 3.794 ng·ml^-1, 3.000 ng·ml^-1) in patients with IGT,T2DM(disease course< 1 year), 10 cases of patients with T2DM(1 year≤disease course <5 years), 10 cases of T2DM(5 years≤disease course< 10 years), and at 60 min(3.923 ng·ml^-1) in T2DM patients(disease course≥10 years). After oral 30 g glutamine, all the subjects's plasma GLP-1 levels were also elevated, the GLP-1 secretion peak were all at 30 min of healthy controls, IGT patients and T2DM patients(disease course< 1 year) (5.488 ng·ml^-1, 3.719 ng·ml^-1, 3.718 ng·ml^-1), while the GLP-1 secretion peak were all at 60 min of T2DM patients(1 year≤disease course<5 years, 5 years≤disease course<10 years, disease course≥10 years)(3.667 ng·ml^-1, 2.399 ng·ml^-1, 2.368 ng·ml^-1). Conclusion: Compared with healthy controls, IGT patients and T2DM patients have different degrees of incretin secretion defect. After oral glucose, the GLP-1 secretion peak level shows a descending trend accompany with diabetes's duration increase. Oral 30 g glutamine can also stimulate GLP-1's secretion in different courses of type 2 diabetic patients. Glutamin may play a role in blood glucose control in patients with type 2 diabetes.

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