瑞格列奈对2型糖尿病血糖及胰岛B细胞功能的影响  

Effects of repaglinide on blood glucose and function of pancreatic beta cells in patients with type 2 diabetics

作　　者：林东平[1] 郭明皓[1] 郭郁郁[1] 陆颖理[1] 吴万龄[1] 

机构地区：[1]上海交通大学医学院附属第九人民医院内分泌科,200011

出　　处：《上海医学》2008年第12期860-863,F0003,共5页Shanghai Medical Journal

摘　　要：目的观察瑞格列奈对2型糖尿病(T2DM)血糖及胰岛B细胞功能的影响。方法40例T2DM患者随机均分为瑞格列奈组(R组)和格列吡嗪组(G组),最后完成研究者共35例。另选8例新诊断的T2DM患者随机均分为A、B两组,作瑞格列奈和格列吡嗪交叉对照试验,其中1例中途退出。第1阶段:R组每次主餐前15 min内口服瑞格列奈1 mg;G组每次主餐前30 min口服格列吡嗪5 mg。第2阶段:上阶段治疗未理想达标者改为联合用药,R组(12例)加二甲双胍递增至0.85 g/次,每日2次;G组餐前加服阿卡波糖50 mg/次,每日3次。第3阶段:停联合治疗,R组恢复单用瑞格列奈1 mg/次,每日3次;G组(11例)恢复单用格列吡嗪5 mg/次,每日3次。交叉对照试验:第1阶段A组服瑞格列奈1 mg/次、每日3次,B组服格列吡嗪5 mg/次、每日3次;8周后进入第2阶段,两组药物互换,维持8周。结果第1阶段:R组与G组间空腹血糖、餐后2 h血糖、糖化血红蛋白治疗前、后差值的差异均无统计学意义(P值均>0.05),而G组餐后2 h胰岛素治疗前、后差值显著高于R组(P<0.05)。第2阶段:R组及G组各时相血糖均进一步下降。第3阶段:R组血清胰岛素又复回升至联合治疗前水平,血糖略有回升,但仍显著低于联合治疗前水平(P<0.05);而G组血糖回升至联合治疗前水平,胰岛素仅略有回升,但显著低于联合治疗前水平(P<0.05)。交叉对照试验:A组与B组的峰值相似,但前者始于60 min,后者始于120～180 min,两组间血糖下降的0～4 h的曲线下面积的差异无统计学意义(P>0.05);胰岛素升高的峰值也近似,但前者始于30～60 min,180 min后基本消失,后者始于120 min,且持续增高。B组胰岛素治疗前、后0～4 h的曲线下面积差值显著高于A组(P<0.05)。结论瑞格列奈模拟生理模式刺激胰岛素早期相分泌,从而减轻胰岛B细胞过度负荷并取得整体血糖的控制,因而可望延缓胰岛B细胞功能的衰竭。Objective To observe the effects of repaglinide on blood glucose and functions of pancreatic beta cells in patients with type 2 diabetes. Methods Forty patients with type 2 diabetes were randomly divided into repaglinede group （group R, n=20） a completed the study. Meanwhile, 8 patient group A and group B （n=4, respectively） glipizide ; 7 nd glipizide group （group G, n=20）. Thirty five patients of the 40 s with newly diagnosed type 2 crosso diabetes were evenly randomized into ver control study with repaglinede and them finished the study eventually. At the first stage, the patients in group R took repag inede （15 min before meal） and those G took glipizide （30 meal）. At the second stage, combination therapy was used for the palients whose treatments were not satisfactory after the first stage treatment： group R （n=12） were also given metformin （0.85 g per time, twice daily） and group G （n= 11） were given acarbose （50 mg per time, 3 times a day）. At the third stage, combined treatment was stopped and the R received repaglinede （1 mg per time, 3 times a day）. The indices related to bl 3 ood glucose and those in group G received glipizide measured. Results At the first stage, there were no significant difference in the decreases of FPG, 2hPG and HbA1 c between group R and group G （P〉0.05）, whereas the change of 2bins in group G was greater than that in group R （P〈0.05） after treatment. At the second stage, the blood glucose of each phase was continuously decreased in 2 groups. At the third stage, the serum insulin in group R was increased and the glucose was gradually decreased. The increase of insulin in group G was inferior to that in group R. The blood glucose in group G nearly restored to initial combination therapy. The crossover control study showed that the glucose peaks were similar in group A and group B, but the peak of group A started one hour was earlier than that of group B. The glucose AUC0-4 h decreases were similar in the 2 groups （P〉0.05）

关 键 词：2型糖尿病 口服糖耐量试验 胰岛素释放试验 瑞格列奈 格列吡嗪 

分 类 号：R587.1[医药卫生—内分泌] R977.15[医药卫生—内科学]