c-peptid (LH Indholdsside)

<Provider Id="sundheddkcms">
  <Item Id="{69701967-CC5A-44F7-89B2-476C6B55F9A3}" Name="c-peptid" Type="LHContentPage" ParentProviderId="sundheddkcms" ParentItemId="{954990FB-BCA1-4322-A1A9-62D3FD4B2E07}" SortOrder="3000" PublishDate="2011-01-11T10:04:00" DeleteDate="2999-12-31T00:00:00" PotItemType="">
    <Content>
      <HtmlField Name="PageContent"><![CDATA[<h2>Resum&eacute;</h2>
<ul>
    <li>Proinsulin C-peptid m&aring;les,&nbsp;n&aring;r egenproduktionen af insulin &oslash;nskes bed&oslash;mt. Det kan&nbsp;f.eks. v&aelig;re ved&nbsp;mistanke om insulinom&nbsp;eller for at skelne mellem insulinkr&aelig;vende og ikke insulinkr&aelig;vende diabetes mellitus. Et niveau p&aring; mindre end 200 pmol/L peger p&aring;&nbsp;<a href="~/link.aspx?_id=6CBEC01CEEED40AFA06F20EC907798E6&amp;_z=z">type&nbsp;1 diabetes</a>&nbsp;<a href="%20" title="Lyngbye J, Kjær A, Ladefoged SA, Nissen PH. Lyngbyes laboratoriemedicin. 2 udg.. København: Nyt Nordisk Forlag Arnold Busck A/S; 2010" data-url="reference-link" data-value-piped="Lyngbye J, Kjær A, Ladefoged SA, Nissen PH|Lyngbyes laboratoriemedicin. 2 udg.|København|Nyt Nordisk Forlag Arnold Busck A/S|2010" data-value="Lyngbye J, Kjær A, Ladefoged SA, Nissen PH. Lyngbyes laboratoriemedicin. 2 udg.. København: Nyt Nordisk Forlag Arnold Busck A/S; 2010" data-type="book-reference">1</a><sup>,</sup><a href="%20" title="Leighton E, Sainsbury CA, Jones GC2, A Practical Review of C-Peptide Testing in Diabetes. Diabetes Ther. 2017;8: 475-487" data-url="reference-link" data-value-piped="Leighton E, Sainsbury CA, Jones GC2|A Practical Review of C-Peptide Testing in Diabetes|Diabetes Ther.|2017|8|475-487" data-value="Leighton E, Sainsbury CA, Jones GC2, A Practical Review of C-Peptide Testing in Diabetes. Diabetes Ther. 2017;8: 475-487" data-type="journal-reference">2</a><sup>,</sup><a href="https://www.nice.org.uk/guidance/ng17/evidence/full-guideline-435400241" title="Type 1 diabetes in adults. Type 1 diabetes in adults: diagnosis and management. National Clinical Guideline Centre. Augst 2015" data-url="https://www.nice.org.uk/guidance/ng17/evidence/full-guideline-435400241" data-value="Type 1 diabetes in adults. Type 1 diabetes in adults: diagnosis and management. National Clinical Guideline Centre. Augst 2015" data-type="other-reference">3</a><sup>,</sup><a href="EditorPage.aspx?da=core&amp;id=%7B69701967-CC5A-44F7-89B2-476C6B55F9A3%7D&amp;ed=FIELD1148605631&amp;vs&amp;la=da&amp;fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&amp;so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&amp;di=0&amp;hdl=H1148606544&amp;mo&amp;pe=0&amp;fbd=1" data-type="journal-reference" data-value="Holt RIG, DeVries JH, Hess-Fischl A, Hirsch IB, Kirkman MS, Klupa T, Ludwig B, Nørgaard K, Pettus J, Renard E, Skyler JS, Snoek FJ, Weinstock RS, Peters AL, The Management of Type 1 Diabetes in Adults. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2021;44: 2589-2625" data-value-piped="Holt RIG, DeVries JH, Hess-Fischl A, Hirsch IB, Kirkman MS, Klupa T, Ludwig B, Nørgaard K, Pettus J, Renard E, Skyler JS, Snoek FJ, Weinstock RS, Peters AL|The Management of Type 1 Diabetes in Adults. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD).|Diabetes Care|2021|44|2589-2625|34593612" data-url="reference-link" data-pubmedid="34593612" title="Holt RIG, DeVries JH, Hess-Fischl A, Hirsch IB, Kirkman MS, Klupa T, Ludwig B, Nørgaard K, Pettus J, Renard E, Skyler JS, Snoek FJ, Weinstock RS, Peters AL, The Management of Type 1 Diabetes in Adults. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2021;44: 2589-2625">4</a></li>
    <li>Proinsulin C-peptid&nbsp;m&aring;les i blodet med eller uden stimulation (fx glukagon eller glukose). Det kan ogs&aring; m&aring;les i d&oslash;gnurin&nbsp;</li>
</ul>
<h2>Definition<a href=" " data-type="journal-reference" data-value="Leighton E, Sainsbury CA,Jones GC, A Practical Review of C-Peptide Testing in Diabetes. Diabetes Ther 2017;8: 475-487" data-value-piped="Leighton E, Sainsbury CA,Jones GC|A Practical Review of C-Peptide Testing in Diabetes|Diabetes Ther|2017|8|475-487" data-url="reference-link" title="Leighton E, Sainsbury CA,Jones GC, A Practical Review of C-Peptide Testing in Diabetes. Diabetes Ther 2017;8: 475-487">5</a></h2>
<ul>
    <li>Koncentrationen af C-peptid (connecting peptide) i plasma, m&aring;lt i nanomol per liter (nmol/L) eller i picomol per liter (pmol/L)</li>
</ul>
<h2>Synonymer</h2>
<ul>
    <li>Synonym: C-Peptid; Proinsulin C-peptid</li>
</ul>
<h2>Indikationer<a href="EditorPage.aspx?da=core&amp;id=%7B69701967-CC5A-44F7-89B2-476C6B55F9A3%7D&amp;ed=FIELD1859913475&amp;vs&amp;la=da&amp;fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&amp;so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&amp;di=0&amp;hdl=H1859913829&amp;us=sitecore%5Cneho&amp;mo&amp;pe=0&amp;fbd=1" title="Leighton E, Sainsbury CA, Jones GC2, A Practical Review of C-Peptide Testing in Diabetes. Diabetes Ther. 2017;8: 475-487" data-url="reference-link" data-value-piped="Leighton E, Sainsbury CA, Jones GC2|A Practical Review of C-Peptide Testing in Diabetes|Diabetes Ther.|2017|8|475-487" data-value="Leighton E, Sainsbury CA, Jones GC2, A Practical Review of C-Peptide Testing in Diabetes. Diabetes Ther. 2017;8: 475-487" data-type="journal-reference">2</a><sup>,</sup><a href="EditorPage.aspx?da=core&amp;id=%7B69701967-CC5A-44F7-89B2-476C6B55F9A3%7D&amp;ed=FIELD1148605631&amp;vs&amp;la=da&amp;fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&amp;so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&amp;di=0&amp;hdl=H1148606544&amp;mo&amp;pe=0&amp;fbd=1" data-type="journal-reference" data-value="Holt RIG, DeVries JH, Hess-Fischl A, Hirsch IB, Kirkman MS, Klupa T, Ludwig B, Nørgaard K, Pettus J, Renard E, Skyler JS, Snoek FJ, Weinstock RS, Peters AL, The Management of Type 1 Diabetes in Adults. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2021;44: 2589-2625" data-value-piped="Holt RIG, DeVries JH, Hess-Fischl A, Hirsch IB, Kirkman MS, Klupa T, Ludwig B, Nørgaard K, Pettus J, Renard E, Skyler JS, Snoek FJ, Weinstock RS, Peters AL|The Management of Type 1 Diabetes in Adults. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD).|Diabetes Care|2021|44|2589-2625|34593612" data-url="reference-link" data-pubmedid="34593612" title="Holt RIG, DeVries JH, Hess-Fischl A, Hirsch IB, Kirkman MS, Klupa T, Ludwig B, Nørgaard K, Pettus J, Renard E, Skyler JS, Snoek FJ, Weinstock RS, Peters AL, The Management of Type 1 Diabetes in Adults. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2021;44: 2589-2625">4</a></h2>
<ul>
    <li>Analysen anvendes overvejende af specialister i diabetologi, og er sj&aelig;ldent relevant i almen praksis
    <ul>
        <li>Der er is&aelig;r ingen grund til at m&aring;le hverken C-peptid eller&nbsp;<a href="~/link.aspx?_id=30829E13A0EC44A48F209B742470CCD9&amp;_z=z">insulin</a>&nbsp;i forbindelse med den rutinem&aelig;ssige udredning og kontrol af patienter med diabetes</li>
    </ul>
    </li>
    <li>Udredning af &aring;rsager til endogen hypoglyk&aelig;mi (se artiklen om&nbsp;<a href="~/link.aspx?_id=309FFD2209A34237B42AF91D9DB19D2B&amp;_z=z">glukose</a>), herunder mistanke om&nbsp;<a href="~/link.aspx?_id=067F4D0A7DAC440895E3854DD8790BD1&amp;_z=z">insulinom</a></li>
    <li>Differentiering mellem&nbsp;<a href="~/link.aspx?_id=6CBEC01CEEED40AFA06F20EC907798E6&amp;_z=z">type 1 diabetes</a>&nbsp;(T1D) og&nbsp;<a href="~/link.aspx?_id=DCFE14276A164929B46269AF2CAE5FA2&amp;_z=z">type 2 diabetes</a>&nbsp;(T2D), dvs. en vurdering af om en patient har nedsat insulinproduktion eller har nedsat insulinf&oslash;lsomhed. Her anbefales det at m&aring;le C-Peptid indenfor 5 timer efter et m&aring;ltid sammen med glukose.&nbsp;&nbsp;</li>
    <li>Vurdering af behovet for insulinbehandling af patienter med&nbsp;<a href="~/link.aspx?_id=DCFE14276A164929B46269AF2CAE5FA2&amp;_z=z">type 2 diabetes</a>, herunder revurdering af patienter som allerede er i behandling (koncentrationen af C-peptid afspejler den endogene insulinproduktion, da eksogent insulin ikke indeholder C-peptid)</li>
    <li>Vurdering af patienter med antistoffer mod insulin</li>
    <li>Vurdering af patienter som er opereret for&nbsp;<a href="~/link.aspx?_id=5E179A64BD87496DB67E5B4511436E72&amp;_z=z">cancer pancreatis</a></li>
</ul>
<h2>Fortolkninger</h2>
<h3>Forh&oslash;jede v&aelig;rdier</h3>
<ul>
    <li>Manifest&nbsp;<a href="~/link.aspx?_id=DCFE14276A164929B46269AF2CAE5FA2&amp;_z=z">type 2 diabetes</a>&nbsp;(T2D) med hyperinsulin&aelig;mi og nedsat insulinf&oslash;lsomhed (&oslash;get insulinresistens)</li>
    <li>Tilstande med nedsat insulinf&oslash;lsomhed, f.eks.&nbsp;<a href="~/link.aspx?_id=9FEF27C7B60445CFBAFE436810A348B7&amp;_z=z">adipositas</a>&nbsp;og/eller&nbsp;<a href="~/link.aspx?_id=F8FD6CEA077F48E58D8BCE067490C91F&amp;_z=z">metabolisk syndrom</a></li>
    <li><a href="~/link.aspx?_id=067F4D0A7DAC440895E3854DD8790BD1&amp;_z=z">Insulinom</a></li>
    <li><a href="~/link.aspx?_id=5022C6009DAA4F739414DE007C6B5F16&amp;_z=z">Akut pancreatitis</a></li>
    <li><a href="~/link.aspx?_id=886DB4E02FA34867A039461C2080CA9B&amp;_z=z">Kronisk nyreinsufficiens</a></li>
</ul>
<h3>Lave v&aelig;rdier</h3>
<ul>
    <li>Manifest&nbsp;<a href="~/link.aspx?_id=6CBEC01CEEED40AFA06F20EC907798E6&amp;_z=z">type 1 diabetes</a>&nbsp;(T1D), herunder ogs&aring; efter omfattende kirurgiske resektioner af pancreas og som komplikation til&nbsp;<a href="~/link.aspx?_id=F61E1F9A4D594FCF8DDAC06DEFC9A759&amp;_z=z">kronisk pancreatitis</a></li>
    <li>Hypoglyk&aelig;mi efter injektion af insulin</li>
    <li>C-Peptid analyseret indenfor 5 timer efter et m&aring;ltid skal vurderes sammen med glukose, som analyseres automatisk ved rekvisition af C-Peptid ikke fastende. Nedenst&aring;ende er konsensus for fortolkning af non-faste P-C-peptid og glukose<a href="EditorPage.aspx?da=core&amp;id=%7B69701967-CC5A-44F7-89B2-476C6B55F9A3%7D&amp;ed=FIELD1148605631&amp;vs&amp;la=da&amp;fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&amp;so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&amp;di=0&amp;hdl=H1148606544&amp;mo&amp;pe=0&amp;fbd=1" data-type="journal-reference" data-value="Holt RIG, DeVries JH, Hess-Fischl A, Hirsch IB, Kirkman MS, Klupa T, Ludwig B, Nørgaard K, Pettus J, Renard E, Skyler JS, Snoek FJ, Weinstock RS, Peters AL, The Management of Type 1 Diabetes in Adults. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2021;44: 2589-2625" data-value-piped="Holt RIG, DeVries JH, Hess-Fischl A, Hirsch IB, Kirkman MS, Klupa T, Ludwig B, Nørgaard K, Pettus J, Renard E, Skyler JS, Snoek FJ, Weinstock RS, Peters AL|The Management of Type 1 Diabetes in Adults. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD).|Diabetes Care|2021|44|2589-2625|34593612" data-url="reference-link" data-pubmedid="34593612" title="Holt RIG, DeVries JH, Hess-Fischl A, Hirsch IB, Kirkman MS, Klupa T, Ludwig B, Nørgaard K, Pettus J, Renard E, Skyler JS, Snoek FJ, Weinstock RS, Peters AL, The Management of Type 1 Diabetes in Adults. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2021;44: 2589-2625">4</a></li>
    <li>P-C-peptid &lt;200 pmol/L og P-Glukose &ge;4 mmol/L: Insulinopen diabetes
    <ul>
        <li>P-C-peptid &gt;600 pmol/L:&nbsp; H&oslash;jst sandsynligt type 2 diabetes</li>
        <li>P-C-peptid mellem 200-600 pmol/L: Gr&aring;zone: diabetes-subtype er usikker; gentag evt. test efter mere end 5 &aring;rs diabetesvarighed</li>
        <li>P-C-peptid &lt; 600 pmol/L og P-Glukose &lt; 4 mmol/L: Test anbefales gentaget</li>
    </ul>
    </li>
</ul>
<h2>Biokemisk baggrund</h2>
<ul>
    <li>Proinsulin best&aring;r af insulin og C-peptid, som sidder mellem A- og B-k&aelig;derne i insulinmolekylet </li>
    <li>Efter spaltning af proinsulin i beta-cellerne i pancreas oplagres b&aring;de insulin og C-peptid, for siden at blive udskilt i &aelig;kvimol&aelig;re m&aelig;ngder, dvs. at koncentrationen af C-peptid i plasma afspejler produktionen og udskillelsen af insulin </li>
    <li>C-peptid har en betydelig l&aelig;ngere halveringstid i plasma end insulin (omkring 20 minutter versus 3-5 minutter). Dette medf&oslash;rer, at koncentrationen af C-peptid typisk er over 5 gange h&oslash;jere end koncentrationen af <a href="~/link.aspx?_id=30829E13A0EC44A48F209B742470CCD9&amp;_z=z">insulin</a> </li>
    <li>Man har tidligere troet, at C-peptid var et inaktivt biprodukt ved produktionen af insulin, men peptidet har en r&aelig;kke biologiske effekter, som bl.a. underst&oslash;tter insulins funktioner </li>
    <li>C-peptid findes ikke i eksogent insulin</li>
</ul>
<h2>Pr&oslash;vetagning</h2>
<h3>Patientforberedelse</h3>
<ul>
    <li>Patienten kan tages enten med eller uden forudg&aring;ende faste</li>
    <li>Pr&oslash;ven kan eventuelt tages i forbindelse med en glukosebelastning eller efter en&nbsp;[DliActiveSubstance;5793;glucagon-injektion]</li>
</ul>
<p><strong>Procedure</strong></p>
<ul>
    <li>Veneblodpr&oslash;ve i r&oslash;r med lithium-heparin eller EDTA, eller uden antikoagulans (t&oslash;rglas)</li>
    <li>Afpipetteret plasma eller serum er holdbart i 3 d&oslash;gn ved stuetemperatur og kan sendes med almindelig post [Unilabs Danmark]</li>
    <li>Nogle laboratorier anbefaler, at plasma eller serum nedfryses hurtigst muligt og sendes som fryseforsendelse (dvs. med t&oslash;ris) til laboratoriet</li>
    <li>Der b&oslash;r rekvireres, tages og medsendes en veneblodpr&oslash;ve til m&aring;ling af&nbsp;<a href="~/link.aspx?_id=309FFD2209A34237B42AF91D9DB19D2B&amp;_z=z">glukose</a></li>
</ul>
<h2>Referenceintervaller</h2>
<ul>
    <li>Der kan v&aelig;re betydelige forskelle i de angivne intervaller fra laboratorium til laboratorium, b&aring;de afh&aelig;ngigt af de anvendte m&aring;lemetoder og referencepopulationen, f.eks:
    <ul>
        <li>0,21-1,15 nmol/L [Unilabs Danmark]</li>
        <li>380- 1630 pmol/L [Steno Diabetes Center]<a href="EditorPage.aspx?da=core&amp;id=%7B69701967-CC5A-44F7-89B2-476C6B55F9A3%7D&amp;ed=FIELD313339168&amp;vs&amp;la=da&amp;fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&amp;so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&amp;di=0&amp;hdl=H313339324&amp;mo&amp;pe=0&amp;fbd=1" data-type="journal-reference" data-value="Larsen PB, Linneberg A, Hansen T, Friis-Hansen L, Reference intervals for C-peptide and insulin derived from a general adult Danish population. Clin Biochem 2017;50(7-8): 408-413" data-value-piped="Larsen PB, Linneberg A, Hansen T, Friis-Hansen L|Reference intervals for C-peptide and insulin derived from a general adult Danish population|Clin Biochem|2017|50(7-8)|408-413" data-url="reference-link" title="Larsen PB, Linneberg A, Hansen T, Friis-Hansen L, Reference intervals for C-peptide and insulin derived from a general adult Danish population. Clin Biochem 2017;50(7-8): 408-413">6</a></li>
    </ul>
    </li>
    <li>Koncentrationen er h&oslash;jere hos gravide i 2. og 3. trimester</li>
</ul>
<h2>NPU-koder og -navne</h2>
<ul>
    <li>NPU18004 P&mdash;C-peptid; stofk. = ? pmol/L</li>
    <li>NPU18005 P(fPt)&mdash;C-peptid; stofk. = ? pmol/L</li>
    <li>NPU18007 P&mdash;C-peptid; stofk.(0 min) = ? pmol/L</li>
    <li>NPU10393: Pancreas beta-celle&mdash;Proinsulin C-peptid-sekretion; stofhast.(liste; glucagon i.v.; proc.) (Efter indgift af glukagon analyseres C-peptid og Glukose p&aring; specifikke tidspunkter herefter: NPU10389, NPU10691, NPU10390, NPU10391, NPU18007, NPU18008, NPU18009, NPU08503, NPU10655, NPU04177)</li>
    <li>NPU18864 Pancreas beta-celle&mdash;Proinsulin C-peptid-sekretion; stofhast.(liste; glucose p.o.; proc.) (Som NPU10393, blot efter indgift af glukose)</li>
</ul>
<p><strong>Kort navn</strong></p>
<ul>
    <li>
    NPU18004&nbsp; og NPU18005 Proinsulin C-peptid;P</li>
    <li>NPU18007 Proinsulin C-peptid (0 min);P</li>
</ul>]]></HtmlField>
      <LinkListField Name="Spot2">
        <LinkField linktype="internal">{99A85AFD-2F7A-4B5D-A1C9-C2701D5E7D30}</LinkField>
      </LinkListField>
      <TextField Name="DoctorsHandbookID">2954</TextField>
      <TextField Name="PageTitle">C-peptid</TextField>
      <TextField Name="NavigationTitle">C-peptid</TextField>
      <CheckBoxField Name="ShowInMenu">true</CheckBoxField>
      <CheckBoxField Name="ShowInContentField">true</CheckBoxField>
      <DateTimeField Name="RevisedDate">2023-01-03T13:53:00</DateTimeField>
      <LinkListField Name="Authors">
        <LinkField linktype="internal">{E3258509-7DFB-4092-BE9F-B584BD8A18BA}</LinkField>
        <LinkField linktype="internal">{ED7CEC94-3F7A-4FB5-BBB0-A3681BCFC481}</LinkField>
      </LinkListField>
      <LinkListField Name="Organization">
        <LinkField linktype="internal">{CF77E8B9-9937-42B2-85DF-76B0F4E401F0}</LinkField>
      </LinkListField>
      <TextField Name="ICPC2">A98</TextField>
      <LinkListField Name="SearchAreaID">
        <LinkField linktype="internal">3</LinkField>
      </LinkListField>
      <TextField Name="Description">Proinsulin C-peptid måles, når egenproduktionen af insulin ønskes bedømt.</TextField>
      <LinkListField Name="LHPHEditor">
        <LinkField linktype="internal">{37FAF8C0-7527-48CA-9ECE-FCC7E8CBB368}</LinkField>
      </LinkListField>
      <TextField Name="__Updated by">sitecore\rith</TextField>
      <TextField Name="MetaKeywords">C-peptid, connecting peptide, proinsulin c-peptid</TextField>
      <LinkListField Name="InformationCategory">
        <LinkField linktype="internal">IC_3</LinkField>
      </LinkListField>
      <LinkListField Name="InformationType">
        <LinkField linktype="internal">7</LinkField>
      </LinkListField>
      <LinkListField Name="SearchTargetGroup">
        <LinkField linktype="internal">2</LinkField>
      </LinkListField>
    </Content>
    <Medias />
  </Item>
</Provider>

18.735 characters