胰岛素治疗简介要点.pptVIP

* Beta cell function progressively declines UKPDS shows that at the time of diagnosis ?-cell function is already markedly compromised by up to 50%, with ?-cell function continuing to deteriorate in the years following diagnosis. Furthermore, extrapolation of these data tells us that ?-cell function in UKPDS patients may have been suboptimal for 10 years prior to diagnosis. Reference UKPDS population: UKPDS 16. Diabetes 1995;44:1249–58 * * 这项来自Butler的研究，收集了一百四十多个胰腺组织标本，来评估β细胞的数量，结果非常具有说服力。 在左侧深色柱所示健康肥胖人群与右侧深色柱所示健康消瘦人群相比，β细胞的量是增加的。这一点与前面所讲一致，可以明确体现机体的代偿机制。但是无论肥胖还是消瘦者，随着糖代谢异常，2型糖尿病发生后，β细胞的数量明显减少。 这张幻灯告诉我们两件信息，第一机体是可以代偿的，第二代偿是有限度的。 In humans, ?-cell mass increases with obesity and decreases with type 2 diabetes In this study, pancreatic tissue from 124 autopsies was examined to assess whether obesity (BMI 27 kg/m2) and type 2 diabetes are related to ?-cell mass (as assessed by relative ?-cell volume). Frequency of ?-cell apoptosis and replication, and new islet formation were also examined to provide possible explanations for alterations in ?-cell mass. Relative ?-cell volume was the ratio of ?-cell area/exocrine area from a representative area of pancreas section. In people without diabetes, increased ?-cell volume was observed in obese people (n = 31) relative to lean people (n = 17; by 34%, p = 0.05). This increase is suggested to be in response to obesity-related insulin resistance and appeared to result primarily from an increase in new islet formation. In contrast, in people with type 2 diabetes, ?-cell mass was significantly decreased in both lean (n = 16) and obese (n = 41) individuals. Specifically, in obese people, ?-cell mass was 63% lower in people with diabetes than in those without (p 0.01). Similarly, in lean people, ?-cell mass was 41% lower in people with diabetes than in those without type 2 diabetes (p 0.05). Further investigations showed that the reduced ?-cell mass in patients with type 2 diabetes may be due to increased ?-cell apopt