早期强化治疗对不同血糖水平新诊断2型糖尿病患者胰岛β细胞功能和预后的影响  

The effects of early intensive therapy on islet beta cell function and long-term glycemia control in newly diagnosed type 2 diabetic patients with different fasting plasma glucose levels

作　　者：李延兵[1] 曾龙驿[2] 时立新[3] 朱大龙[4] 周智广[5] 严励[6] 田浩明[7] 罗佐杰[8] 杨立勇[9] 刘娟[1] 翁建平[2] 

机构地区：[1]中山大学附属第一医院内分泌科,广州510080 [2]中山大学附属第三医院内分泌科 [3]贵阳医学院附属医院内分泌科 [4]南京大学鼓楼医院内分泌科 [5]中南大学湘雅二医院内分泌科 [6]中山大学附属第二医院内分泌科 [7]四川大学华西医院内分泌科 [8]广西医科大学第一附属医院内分泌科 [9]福建医科大学第一附属医院内分泌科

出　　处：《中华内科杂志》2010年第1期9-13,共5页Chinese Journal of Internal Medicine

基　　金：基金项目：国家973计划（2006AA02A409）;广东省自然基金重点项目（9251008901000030）;卫生部2007-2009年度临床学科重点项目

摘　　要：目的评价早期强化治疗对不同血糖水平新诊断2型糖尿病患者胰岛B细胞功能和预后的影响。方法382例新诊断2型糖尿病患者随机给予持续皮下胰岛素输注（CSII）、每日多次胰岛素注射（MDI）及口服降糖药（OHA）短期强化治疗，治疗前后测血糖、血脂及游离脂肪酸（FFA）、空腹胰岛素原与空腹胰岛素比值（PI／I），行静脉葡萄糖耐量试验（IVGTT），评价胰岛素急性分泌时相（AIR），计算稳态模型β细胞功能指数（HOMA—β）和胰岛素抵抗指数（HOMA-IR）。随访1年以上。根据入选时空腹血浆血糖（FPG）水平进行分层分析，A层：7．0mmoL／L≤FPG〈11．1mmol／L。B层：11．1mmol／L≤FPG≤16．7mmol／L。结果A层患者的治疗达标率更高（94．4％比89．8％），血糖达标时间更短，1年缓解率也更高（47．8％比35．7％，P〈0．05）；而B层患者治疗后血糖、血脂的改善和FFA的下降更明显，且HOMA-β增加更多，但A、B层患者间AIR、PI／I比值和HOMA—IR改善程度差异无统计学意义。而无论A层或B层，胰岛素治疗（CSII、MDI）较OHA组有更高的1年缓解率（A层：57．1％，51．8％比32．8％，P〈0．05；B层：44．4％，38．7％比18．6％，P〈0．05）。结论短期胰岛素强化治疗较口服药治疗不仅使FPG较高的2型糖尿病患者具有更高的1年缓解率，在FPG轻中度增高的患者中获益也较大。Objective To investigate the effects of early intensive therapy on β cell function and long-term glyeemie control in newly diagnosed type 2 diabetic patients with different recruiting fasting plasma glucose （FPG） levels. Methods A total of 382 newly diagnosed type 2 diabetic patients with FPG 7.0- 16.7 mmol/L were randomly assigned to therapy with insulin in the form of continuous subcutaneous insulin infusion （CSII） or multiple daily injection （MDI） or oral hypoglyeemie agents （OHA, by using gliclazide and/or metformin ） for initial rapid correction of hyperglycemia. The treatments were stopped after euglycemia had been maintained for 2 weeks. The patients were followed longitudinally on diet alone for 1 year. Intravenous glucose tolerances tests （IVGITs） were performed and blood glucose, insulin and proinsulin were measured before and after therapy as well as at 1-year follow-up. Homeostasis model assessment（HOMA） of β cell function and insulin resistance index （HOMA-β and HOMA-IR）werecalculated. All the patients were stratified on the recruiting FPG： stratum A （7.0 mmol/L ≤ FPG 〈 11.1 mmol/L）, stratum B （ 11.1 mmol/L ≤ FPG ≤ 16. 7 mmol/L ）. Results More patients in stratum A achieved target glycemic control （94.4% vs 89.8% ） and in shorter time [ （5.9 ±3.8）d vs（6.9 ±3.6）d, P 〈 0. 051 as compared with those in stratum B. J5 cell function represented by HOMA-β and acute insulin response （AIR） improved significantly after intensive interventions in both stratum A and B patients. However, the remission rate at 1 year was significantly higher in stratum A patients （47.8%） than those in stratmn B （35.7%, P 〈 0.05 ）. The patients treated with insulin （especially with CSII ） had higher remission rates and better improvement of AIR at 1 year follow-up irrespective of the recruiting FPG （ CSII or MDI vs OHA： 57.1%, 51.8% vs 32. 8% in stratum A, P 〈0. 05 ; 44.4%, 38.7% vs 18.6% in stratum B, P 〈0.05）. Conclusions Compared with O

关 键 词：糖尿病 2型 胰岛素分泌细胞 强化治疗 

分 类 号：R587.1[医药卫生—内分泌] R631[医药卫生—内科学]