评估胰岛素分泌及胰岛素敏感性选择降糖药物的临床多中心研究  

Evaluation of insulin secretion and insulin sensitivity in the selection of hypoglycemic drugs——a mulficentre clinical study

作　　者：包玉倩[1] 贾伟平[1] 高鑫[2] 刘伟[3] 邢惠莉[4] 刘志民[5] 盛正妍[6] 胡仁明[7] 宁光[8] 邹大进[9] 冯波[10] 陆俊茜[1] 周健[1] 项坤三[1] 

机构地区：[1]上海交通大学附属第六人民医院内分泌代谢科,上海市糖尿病临床医学中心,上海市糖尿病研究所,200233 [2]复旦大学附属中山医院内分泌科 [3]上海交通大学医学院附属仁济医院内分泌科 [4]上海交通大学医学院附属新华医院内分泌科 [5]第二军医大学附属长征医院内分泌科 [6]上海交通大学附属第一人民医院内分泌科 [7]复旦大学附属华山医院内分泌科 [8]上海交通大学医学院附属瑞金医院内分泌代谢科 [9]第二军医大学附属长海医院内分泌科 [10]上海同济大学附属东方医院内分泌科

出　　处：《中华内分泌代谢杂志》2007年第2期104-109,共6页Chinese Journal of Endocrinology and Metabolism

基　　金：上海市科学技术发展基金[01ZD002(1)]

摘　　要：目的评价糖尿病病理生理变化对新诊断的2型糖尿病患者治疗的指导意义。方法按照精氨酸刺激试验的结果,将322例新诊断2型糖尿病患者分为一相胰岛素分泌正常组和低下组,将前者随机分配至瑞格列奈、罗格列酮及二甲双胍治疗组,后者随机分配至瑞格列奈、罗格列酮及格列吡嗪治疗组。结果(1)各药物治疗组,用药后3个月、6个月的空腹血糖、餐后2 h血糖及HbA_(1C)均较基线明显降低(均P<0.01)。治疗后6个月HbA_(1C)控制理想的总体达标率为63.5%。(2)在一相胰岛素分泌正常组,罗格列酮治疗后血糖校正后的精氨酸试验胰岛素曲线下面积(AUC)明显增加,胰岛素原显著减少(P<0.01),二甲双胍治疗后胰岛素抵抗指数(HOMA-IR)较基线显著降低(P<0.05)。(3)在一相胰岛素分泌低下组,瑞格列奈或格列吡嗪治疗后的精氨酸试验的2、4、6 min真胰岛素均值与空腹真胰岛素的差值(△TI)、血糖校正后精氨酸试验的结果(△TI/PG)、AUC及真胰岛素(11)明显增高(P<0.05或P<0.01),罗格列酮组治疗后的△TI/PG与AUC显著增加,而HOMA-IR及胰岛素原较治疗前明显减少(均P<0.01)。结论(1)基于糖尿病病理生理变化正确评估的药物治疗,可有效控制新诊断2型糖尿病患者的糖代谢紊乱。(2)瑞格列奈及格列吡嗪可增加2型糖尿病患者的一相胰岛素分泌及真胰岛素水平。(3)罗格列酮不仅可以增加机体的胰岛素敏感性,减少胰岛素原的分泌,尚可改善一相胰岛素分泌低下者的一相胰岛素分泌功能。(4)新诊断2型糖尿病患者血糖的有效控制,主要与机体胰岛素分泌功能的改善及胰岛素敏感性的增加有关。Objective To evaluate the pathophysiological change of diabetes and its significance in the treatment of newly-diagnosed type 2 diabetic patients. Methods A total of 322 newly-diagnosed type 2 diabetic patients were included in this study and were divided into 2 groups with normal or impaired islet first-phase insulin secretion according to arginine stimulation test. The former group was assigned to repaglinide （Novo Norm）, rosiglitazone （Avandia） and mefformin subgroups and the latter one to repaglinide, rosiglitazone and glipizide subgroups randomly. Results （1） Compared with baseline, fasting plasma glucose, 2 h postprandial plasma glucose and HbA1C were significantly decreased in all subgroups after 3 and 6 months of treatment （ all P 〈 0.01 ） and the percentage of well controlled HbA1C was 63.5 % after 6 months of treatment. （2） In the group with normal first-phase insulin secretion, the area under the curve for insulin （AUC） in arginine stimulation test was increased and proinsulin （PI） was reduced in rosiglitazone subgroup （both P 〈 0. 01 ） and HOMA-IR was decreased in mefformin subgroup as compared with baseline （ P 〈 0. 05 ）. （ 3 ） In the group with impaired acute insulin secretion, the increments in true insulin （△TI）、△TI/PG、AUC and true insulin （TI） were marked in both repaglinide and glipizide subgroups （ P 〈 0.05 or P 〈 0.01 ） as compared with baseline. In rosiglitazone subgroup △TI/PG and AUC were increased and HOMA-IR and PI were decreased （ all P 〈 0.01 ）. Conclusion （ 1 ） In newly-diagnosed type 2 diabetic patients, the level of blood glucose is effectively controlled by oral hypoglycemie agents if they were properly assigned according to the evaluation of pathophysiologieal change. （2） Acute insulin release and TI is increased in newly-diagnosed type 2 diabetic patients treated with repaglinide and glipizide. （3） Rosiglitazone not only improves β-cell function by increasing insulin sensitivity and decreasi

关 键 词：糖尿病 2型 精氨酸刺激试验 一相胰岛素分泌 胰岛素抵抗 

分 类 号：R587.1[医药卫生—内分泌]