米格列奈与瑞格列奈对新诊断2型糖尿病的临床疗效研究  

Clinical efficacy of mitiglinide and repaglinide in treatment of patients with newly diagnosed type 2 diabetes mellitus

作　　者：金晖[1] 鲍洁[1] 赵镇[1] 孙子林[1] 

机构地区：[1]东南大学附属中大医院内分泌科,南京210009

出　　处：《第三军医大学学报》2013年第3期260-263,共4页Journal of Third Military Medical University

摘　　要：目的比较米格列奈与瑞格列奈对新诊断2型糖尿病患者(T2DM)在糖代谢、心血管危险因子、氧化应激方面的影响,了解米格列奈药物的短期和中期疗效。方法 2010年4月至2011年1月在我院新诊断90例T2DM患者按随机数字表法分为A、B组(n=45),A组给予瑞格列奈+二甲双胍,B组给予米格列奈+二甲双胍,应用动态血糖监测系统(CGMS)记录3 d内的动态血糖水平和波动趋势,之后12周定期随访相应指标。结果 2组治疗后3 d,空腹血糖、3餐后平均血糖(MBG)及日内血糖平均水平均较治疗前降低,B组餐后1 h及2 h MBG降幅大于A组(P<0.05),平均血糖波动幅度(MAGE)小于A组(P<0.05);12周后,2组空腹及餐后1、2 h血糖均明显降低,B组降幅大于A组;空腹及餐后1、2 h胰岛素(FINS、1 h INS、2 h INS)不同程度升高,B组1 h INS、2 h INS增幅大于A组;B组降低HbA1c幅度大于A组;2组均能降低胰岛素抵抗指数(HOMA-IR)、升高胰岛素敏感指数(ISI),B组优于A组(P<0.05);B组低血糖发生人次低于A组。2组均能不同程度降低总胆固醇(TC)、甘油三酯(TG)、纤维蛋白原(FG)水平,升高高密度脂蛋白胆固醇(HDL-c)水平,2组对纤溶酶原激活物抑制因子-1(PAI-1)下降作用均不明显(P>0.05);B组降低超氧化物歧化酶(SOD)、升高丙二醛(MDA)优于A组(P<0.05)。结论米格列奈与瑞格列奈均能在短期内降低新诊断T2DM患者的血糖,但米格列奈组平均血糖波动幅度小;中期治疗后,与瑞格列奈比较,米格列奈能更好地提高糖化血红蛋白达标率,降低低血糖发生率,改善氧化应激因子。Objective To compare the effect of mitiglinide and repaglinide on glycometabolism, cardiovascular risk factors and oxidative stress in patients with newly diagnosed type 2 diabetes mellitus （T2DM）. Methods Ninety newly diagnosed T2DM patients were randomly assigned to group A and group B. The patients of group A received repaglinide plus metformin treatment, while those of group B were given mitiglinide plus metformin treatment. Continuous glucose monitoring system （CGMS） was used to record the dynamic changes and fluctuation of blood glucose in all patients during the first 3 days. All the patients were followed up to examine the corresponding indices after 12 weeks. Results After treatment for 3 days, the fasting blood glucose （ FBG）, mean blood glucose （MBG） at 30 rain, and 1, 2 and 3 h after meals, and 24 h MBG decreased in both groups. The decrease of 1 h MBG and 2 h MBG was more significant in group B than in group A （ P 〈 0.05 ）, while the mean amplitude of glycemic excursion （ MAGE ） was significantly lower in group B than in group A （ P 〈 O. 05 ）. Twelve weeks later, FBG and postprandial blood glucose （ 1 h PBG and 2 h PBG） significantly decreased in both groups （ P 〈 0.05 ） , and the decrease in group B was more significant than that in group A （P 〈 0.05 ）. Fasting insulin （FINS） and postprandial insulin （ 1 h INS and 2 h INS） increased in both groups, and the increase of 1 h INS and 2 h INS was more significant in group B than in group A （P 〈0.05）. Glycosylated hemoglobin-Ale（ HbAI~ ） in both groups decreased （P 〈0.05）, and the decrease was more significant in group B than in group A. Both groups could significantly decrease the level of HOMA insulin resistance （HOMA-IR） and increase the level of insulin sensitive index （ISI） （P 〈 O. 05 ） , and the effect was more significant in group B than in group A （ P 〈 0.05 ）. The proportion of hypoglycemia in group Bwas lower than that in group A. Both groups could partly

关 键 词：2型糖尿病 米格列奈 瑞格列奈 动态血糖监测系统 

分 类 号：R587.1[医药卫生—内分泌] R969.4[医药卫生—内科学]