控制血糖对2型糖尿病患者胰岛β细胞功能的改善作用——那格列奈和瑞格列奈的双盲随机对照研究  

Plasma glucose reduction improves islet β-cell function in subjects with type 2 diabetes——a double-blind, randomized, parallel controlled trial of Nateglinide and Repaglinide

作　　者：王甫能[1] 廖志红[1] 胡国亮[1] 李延兵[1] 欧香忠[1] 翁建平[1] 

机构地区：[1]中山大学附属第一医院内分泌科,广州510080

出　　处：《中华内分泌代谢杂志》2005年第5期428-431,共4页Chinese Journal of Endocrinology and Metabolism

摘　　要：目的探讨那格列奈和瑞格列奈的降糖作用及对2型糖尿病患者胰岛β细胞功能的影响.方法用随机双盲双模拟平行对照的方法,42例初诊、未经降糖药物治疗的2型糖尿病患者分组给予那格列奈60～90 mg或瑞格列奈0.5～1.0 mg治疗12周,治疗前及停药24 h后测定血糖及胰岛素(INS)、胰岛素原(PI)并行静脉葡萄糖-胰岛素释放试验(IVG-IRT). 结果 37例完成试验,其中18例为那格列奈,19例为瑞格列奈.那格列奈及瑞格列奈治疗后空腹血糖(FPG)、餐后2 h血糖(2hPG)及HbA1C均有明显降低(P＜0.05或P＜0.01),胰岛素原(PI)、PI与空腹胰岛素比值(PI/FINS)及胰岛素抵抗指数(HOMA-IRI)明显下降(P＜0.05或P＜0.01),而胰岛β细胞功能指数(HOMA-β)、静脉葡萄糖耐量试验10 min内胰岛素曲线下面积(AUCINS0-10min)及急性胰岛素反应(AIR)明显增加(均P＜0.01).结论那格列奈和瑞格列奈均能通过显著降低血糖而改善初诊2型糖尿病患者胰岛β细胞功能,胰岛素分泌的质和量均获得改善,能轻微恢复急性胰岛素反应,同时胰岛素抵抗也得到改善.Objective To explore modification of islet β-cell function in subjects with type 2 diabetes after 12-week treatment of nateglinide or repaglinide. Methods The study was a 12-week double-blind, randomized, parallel controlled trial. A total of 42 subjects with newly diagnosed type 2 diabetes without previous treatment of hypoglycaemic agents were recruited. They were randomized into two groups, one group receiving 60-90 mg nateglinide while the other group receiving 0.5-1.0 mg repaglinide 10 min before each meal. Before treatment, fasting plasma glucose （FPG） , postprandial 2 h plasma glucose （2hPG） , HbA1C, fasting insulin （FINS） , proinsulin （PI） concentrations were measured and intravenous glucose insulin release test （IVG-IRT） was performed, and insulin levels at 2, 4, 6 and 10 min after intravenous injection of 50 ml 50% glucose were also measured. After 12 week follow-up, the above profiles and IVG-IRT were repeated 24h after cessation of medication. Results Thirty-seven subjects completed the trial, 19 received repaglinide and 18 nateglinide. Compared to baseline, there were significant reductions in FPG [ （7.3±1.6）mmol/L vs （9.1±1.7 ）mmol/L] , 2hPG[（10.2±3.2）mmol/Lvs （15.3±3.1）mmol/L] and HbA1C[（6.2±0.8）% vs （8.1±1.6）%], PI [ （21.8±15.7）pmol/L vs （31.6±19.0） pmol/L], PI/FINS （0.219±0.113 vs 0.298±0. 121 ） and HOMAIRI （4.39±1.99vs5.88±2.25） （P〈0.05 or P〈0.01）, While HOMA-β（87.9±75.1 vs 58.2±32.2）, AUCINS0-10mim[ （ 1494±798 ） pmol·L^-1·min^-1 vs （ 1020±425 ） pmol·L^-1·min^-1and acute insulin respond （AIR） [ （518±631）pmol·L^-1·min^-1vs （ -41±244）pmol·L^-1·min^-1 increased significantly （all P 〈 0.01）. Before treatment, all subjects had lost AIR, however, after 12-week trial, all of them restored AIR to a certain extent. There were significant reductions in 2hPG, HbA1C, HOMA-IRI, PI and PI/FINS and significant increments in both HOMA-β and AIR in both groups （ all P 〈 0.05） , whi

关 键 词：血糖控制 2型糖尿病 胰岛Β细胞 细胞功能 那格列奈 瑞格列奈 

分 类 号：R587.1[医药卫生—内分泌]