短期胰岛素强化治疗改善初诊2型糖尿病患者胰岛β细胞功能  

Transient intensive insulin therapy improves pancreatic beta-cell function in newly diagnosed type 2 diabetic patients

作　　者：高虹[1] 李启富[1] 黄健康[1] 邓吉容[1] 刘秀容[1] 刘智平[1] 张素华[1] 

机构地区：[1]重庆医科大学附属第一医院内分泌科,400016

出　　处：《重庆医学》2004年第10期1477-1479,共3页Chongqing medicine

摘　　要：目的　观察短期胰岛素强化治疗对初诊 2型糖尿病患者胰岛 β细胞功能和血糖控制的影响。方法　对初诊 2型糖尿病患者用静脉葡萄糖耐量试验 (IVGTT)和精氨酸刺激试验两种方法检测β细胞功能后 ,给予 2周的胰岛素强化治疗 (采用每日多次皮下注射胰岛素法 )。比较治疗前后血糖、胰岛 β细胞对葡萄糖和精氨酸刺激的胰岛素第一时相分泌的变化、空腹胰岛素与空腹血糖比值 (FINS/FPG)、Homa β、Homa IR和胰岛素敏感指数 (ISI)。结果　 2 5例纳入研究 ,18例完成。治疗结束时 ,所有患者血糖均达到理想控制 ,空腹和餐后 2h血糖较治疗前明显降低 (P <0 .0 0 1)。静脉葡萄糖耐量试验胰岛素第一时相分泌、曲线下面积 (AUC)、Homa β和FINS/FPG治疗后有明显升高 (P <0 .0 5 )。反映胰岛素抵抗的Homa IR治疗后明显下降 ,ISI明显升高(P <0 .0 5 )。精氨酸刺激试验胰岛素第一时相分泌无明显变化 (P =0 .7)。随访 3个月时 ,4例患者仅靠饮食和运动血糖控制满意 ,其余患者均需加用降糖药物才能使血糖达到良好控制。结论　对早期 2型糖尿病患者进行短期胰岛素强化治疗可以快速控制高血糖 ,改善葡萄糖刺激的胰岛素第一时相分泌 ,但对精氨酸刺激的胰岛素第一时相分泌无影响。Objective To study the effect of transient intensive insulin therapy on glycemic control and beta-cell function in newly diagnosed type 2 diabetic patients.Methods Twenty-five newly diagnosed type 2 diabetic patients were treated by multiple daily injection(MDI) for 2 weeks and their beta-cell function were assessed by intravenous glucose tolerance test and arginine stimulation test.Plasma glucose ,the first-phase insulin secretion stimulated by glucose and arginine,the ratio of fasting insulin and fasting plasma glucose(FINS/FPG),Homa-β,Homa-IR and insulin sensitive index(ISI)before and after the insulin treatment were analysed and compared.After the treatment,all patients were followed up for their glycemic control.Results At the end,18 patients completed the study and all the patients obtained perfect glycemic control.FPG and 2h post prandial glucose(2hPG) decreased significantly(P<0.05)after 2-weeks intensive insulin therapy.The first-phase insulin secretion stimulated by glucose,the mean AUC of insulin,Homa-β and the ratio of FINS/FPG increased significantly(P<0.05).Insulin sensitivity(Homa-IR and ISI)was considerably improved after the treatment.There was no significant change of the first-phase insulin secretion stimulated by arginine (P= 0.7 ).During 3 months followed-up,four patients kept perfect glycemic control only with diet and exercise,and for others antihyperglycemic drugs were needed.Conclusion Transient intensive insulin therapy in the early phase of type 2 diabetes can effectively control hyperglycemia and improve the first-phase insulin secretion stimulated by glucose,but has no effect on the first-phase insulin secretion stimulated by arginine.

关 键 词：2型糖尿病 强化胰岛素治疗 胰腺Β细胞 

分 类 号：R587.1[医药卫生—内分泌]