不同种类口服降糖药联用对2型糖尿病患者动脉内膜中层厚度和斑块发生的影响  

Effects of combination of antidiabetic agents on artery intima-media thickness and plaque occurrence

作　　者：巴根[1] 王奇金[1] 缪雄[1] 丁长花[1] 冯正康[1] 黄勤[1] 邹大进[1] 

机构地区：[1]第二军医大学长海医院内分泌科,上海200433

出　　处：《中国实用内科杂志》2011年第9期693-696,共4页Chinese Journal of Practical Internal Medicine

基　　金：第二军医大学大学生创新能力培养基金(MS2010089);国家"十一五"科技支撑课题(2006BAI02B08);国家"十五"科技支撑支撑课题(2001BA702B01);国家"十五"科技支撑支撑课题(2004BA702B)

摘　　要：目的探讨不同种类口服降糖药联用对2型糖尿病患者动脉内膜中层厚度(intima-media thick-ness,IMT)和斑块发生率的影响。方法选取初发2型糖尿病患者139例(2002年),将患者分为一种、两种、三种口服降糖药物单用组(SING、DOUB、TRIP)和不使用口服降糖药物组(NONE)及对照组。对比分析随访第6年(07年)和第8年(09年)各组颈动脉、髂动脉及股动脉的IMT值与斑块发生率以及其他临床指标的变化情况。结果 (1)TRIP组09年胰岛素(insulin,INS)水平与07相比略有降低。(2)TRIP组09年动脉IMT与07年相比有下降趋势,而对照组动脉IMT值显著升高(P<0.05)。(3)TRIP组的动脉斑块发生率低于同期其他各组对应的动脉斑块发生率(P<0.05)。(4)口服降糖药物联用种类与动脉斑块发生率具有明显相关性(P<0.05)。(5)本研究证明INS是颈动脉斑块发生的危险因子(P<0.05),餐后2 h血糖(2hPG)和INS为髂动脉斑块发生的危险因子(P<0.05)。结论罗格列酮+二甲双胍+格列吡嗪三种口服降糖药联用的三联疗法能控制胰岛素升高,延缓甚至逆转脉内膜增厚进程并且能够抑制动脉斑块发生,是较全面的防治2型糖尿病大血管病变的综合疗法。Objective To investigate the change of artery intima-media thickness （IMT） and plaque incidence in patients with type 2 diabetic in response to combination of antidiabetie agents. Methods Totally 139 newly diagnosed type 2 diabetic patients （2002） were divided into five groups： single-oral-hypoglycemie-therapy group （ SING）, double-oral-hypoglycemic-therapy group（ DOUB）, triple-oral-hypoglycemic-therapy group（TRIP）, none-oral-hypoglycemic-therapy group （NONE） and control group. The IMT as well as the plaque incidence in carotid artery, femoral artery and iliac artery together with other clinical indicators were measured and compared. Resuits （ 1 ） The INS of TRIP group at 09 slightly decreased compared with that at 07. （2） The artery IMT of TRIP group at 09 had a decreased trend compared to that at 07, while the control group all increased （ P 〈 0.05 ）. （ 3 ） The artery plaque incidence of TRIP group was markedly lower than that of other groups at the same time endpoint （P 〈 0. 05 ）. （4）The sorts of combined antidiabetic agents were highly associated with the incidence of carotid and iliac artery plaque （ P 〈 0. 05 ）. （5） Among all clinical indicators in this study, INS was identified as a risk factor for carotid artery plaque incidence （P 〈 0.05 ）,2hPG and INS for iliac artery plaque （P 〈 0.05 ）. Conclusion Triple oral hypoglycemie therapy （rosiglitazone in combination with glimepiride plus metformin） improves insulin control, attenuates and even reverses the progression of artery IMT and delays the occurrence of artery plaque. Tri- ple therapy shows a synergistic effect in T2DM macrovaseular disease.

关 键 词：2型糖尿病 动脉内膜中层厚度 动脉斑块发生 强化降糖 

分 类 号：R587.1[医药卫生—内分泌]