慢性胰腺炎后糖尿病患者胰腺和胃肠激素变化特征的初步研究
| 作 者：陶红, 叶鋆, 谢金金, 李一凡, 潘妍羽, 赵琪, 陈佳云 |
| 单 位：海军军医大学第一附属医院 |
| 基金项目： |
| 摘 要： |
| 背景：慢性胰腺炎（CP）是导致胰腺外分泌疾病相关糖尿病（DEP）的主要原因，其中慢性胰腺炎后糖尿病（PPDM-C）作为一种特殊类型的糖尿病，其发病机制和鉴别诊断尚不明确。目的：分析单纯CP、CP伴糖耐量减低（IGT）、PPDM-C和CP伴2型糖尿病（T2DM）患者馒头餐试验后的胰腺和胃肠激素水平变化，为阐明PPDM-C的发病机制以及区分PPDM-C与单纯CP提供线索。方法：2023年4月—6月，海军军医大学第一附属医院收治的5例CP、6例CP+IGT、5例PPDM-C和4例CP+T2DM患者纳入研究，所有受检者均完成馒头餐试验，并收集血液样本检测血清促生长激素释放素（ghrelin）、抑胃肽（GIP）、胰高血糖素样肽（GLP）-1、胰高血糖素、胰多肽（PP）水平，分析餐后PP水平的曲线下面积（AUC），以及PP与ghrelin之间的关系。结果：馒头餐刺激后各时间点ghrelin、GIP、PP水平在不同类型CP患者间总体差异显著（P均<0.05）。PPDM-C患者空腹和餐后ghrelin水平均高于其他类型CP患者，餐后PP水平均低于其他类型CP患者，与单纯CP组间差异有统计学意义（P均<0.05）。胰岛功能受损患者餐后各时间点PP水平的AUC均低于单纯CP患者（P均<0.05），以PPDM-C患者下降最为显著。PPDM-C患者的餐后PP水平下降与ghrelin分泌增加之间未见相关性。结论：与单纯CP患者相比，PPDM-C患者馒头餐刺激后存在ghrelin、PP反应降低，提示有可能通过动态监测两者在CP患者中的变化趋势早期识别出存在向PPDM-C进展风险的高危人群。 |
| 关键词：慢性胰腺炎后糖尿病； 促生长激素释放素； 胰多肽； 内分泌特征 |
Changes of Pancreatic and Gastrointestinal Hormones in Patients With Post-chronic Pancreatitis Diabetes Mellitus: A Preliminary Study
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| Abstract: |
| Background: Chronic pancreatitis (CP) is the main cause of diabetes of exocrine pancreas (DEP), among which post-chronic pancreatitis diabetes mellitus (PPDM-C), as a special type of diabetes, remains unclear in terms of its pathogenesis and differential diagnosis. Aims: To investigate the changes of pancreatic and gastrointestinal hormones after steamed bread test in patients with CP alone, CP with impaired glucose tolerance (IGT), PPDM-C, and CP with type 2 diabetes mellitus (T2DM), in order to clarify the pathogenic mechanism of PPDM-C and distinguish PPDM-C and CP alone. Methods: From April to June 2023, a total of 5 patients with CP, 6 with CP+IGT, 5 with PPDM-C, and 4 with CP+T2DM admitted to the First Affiliated Hospital of Naval Medical University were included in this study. All patients completed the steamed bread test, and their blood samples were collected for determination of serum levels of growth hormone-releasing peptide/inducing (ghrelin), gastric inhibitory polypeptide (GIP), glucagon-like peptide (GLP)-1, glucagon and pancreatic polypeptide (PP). The area under the curve (AUC) of postprandial PP levels and the correlation between PP and ghrelin were analyzed. Results: After steamed bread stimulation, the overall differences in ghrelin, GIP, and PP levels at various time points were significant among different types of CP patients (all P<0.05). In PPDM-C patients, the fasting and postprandial levels of ghrelin were higher than those in other CP patients, while the postprandial level of PP was lower. Significant differences could be observed between patients with PPDM-C and CP alone (all P<0.05). The AUC of postprandial PP in patients with impaired islet function, especially PPDM-C, were significantly lower than those in patients with CP alone at each time point (all P<0.05). There was no correlation between the reduced PP level and the elevated ghrelin secretion in PPDM-C patients. Conclusions: Compared with patients with CP alone, patients with PPDM-C showed reduced ghrelin and PP responses after steamed bread stimulation, suggesting that dynamic monitoring of the changing trends of ghrelin and PP in CP patients may help to early identify high-risk individuals who are at risk of progressing to PPDM-C. |
| Keywords: Post-Chronic Pancreatitis Diabetes Mellitus; Ghrelin; Pancreatic Polypeptide; Endocrine Characteristics |
| 投稿时间：2025-09-03 |
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