胰岛素和磺脲类对可疑LADA患者胰岛β细胞功能的影响  

Effect of Sulfonylureas and NPH on β-Cells' Function of Patients with "LADA"

作　　者：王新民 韩兵[2] 徐平[2] 

机构地区：[1]暨南大学第二临床医学院深圳市人民医院内分泌科,广东深圳518020 [2]暨南大学第二临床医学院

出　　处：《中国误诊学杂志》2007年第4期677-679,共3页Chinese Journal of Misdiagnostics

摘　　要：目的：观察胰岛素（NPH）和磺脲类降糖药（SU）对可疑成人晚发型自身免疫性糖尿病（LADA）患者免疫学标记物及胰岛β细胞功能等指标的影响。方法：列103例可疑LADA患者在生活方式干预相对固定和其他口服降糖药不变的前提下，分别于0～8周和16～24周使用NPH；8～16周使用SU（Euglucon2．5rag／片或Diamicron 80mg／片或Minidiab 5mg／片）控制血糖于相近水平；于0、8、16和24周检测并比较患者的糖脂和尿酸代谢、自身抗体、标准餐负荷下的血糖和C肽曲线，8周和24周的NPH，以及16周的SU用量等指标。结果：NPH和SU治疗后可疑LADA患者的糖脂和尿酸代谢指标均明显改善（P〈0．01），但SU治疗后GAD—Ab滴度和ICA阳性率都明显升高（P〈0．05），且再次使用NPH需要量明显增加（P〈0．05）；2种治疗标准餐负荷后的血糖曲线无明显差异（P〉0．1），但SU治疗的C肽曲线明显低于NPH治疗（P〈0．05）。结论：SU能有效控制可疑LADA患者的糖代谢，但可加重其胰岛免疫损害；而胰岛素则能减轻胰岛免疫损害并可能保护β细胞功能，故对可疑LADA患者应尽早使用胰岛素治疗。Objective：To observe the changes of the autoantibodies and β-cell＇ function of patients with“LADA” treating by NPH or Sulfonylureas （SU） . Methods ：We treated 103 ＂LADA＂ patients with NPH or SU respectively for 8 weeks at the same conditlon（e, g. the similar llfe-style and same dosage of other antihyperglycemics）. To observe and compare all patients＇ metabolic indexes of glucose and lipid and uric acid,and their GAD-Ab and ICA levels and glycemia curves and c-peptide curves after standard meal at two treatment stages （e. g. NPH and SU）. Results ：Both NPH and SU could ameliorate all patients＇ metabolic indexes of glucose and lipid and uric acid combining with similar llfe-style and same dosage of other antihyperglymics （P〈0.01）. The patients＇ serum GAD-Ab tltre and ICA positive at SU stage was higher than those at NPH stage （P〈0. 05）. And their c-peptlde curve at SU stage was lower than that at NPH stage （P 〈0.05）,but there was no difference at their glycemia curves between two stage （P〉0.1）. Conelusion：SU can control the hyperglycemia of patients with ＂LADA＂,but may be harmful to the function of their β-eells. NPH is also effective to treat their hyperglycemia and maybe favorable to prevent their β-cells from immunological lesion.

关 键 词：糖尿病 I型/药物疗法 磺酰脲化合物/治疗应用 胰岛素/治疗应用 胰岛/病理生理学 

分 类 号：R587.105.3[医药卫生—内分泌]