初发糖尿病胰岛素强化治疗后5年胰岛功能及心血管危险因素变化的评估  

Research on β-cell function cardiovascular risk factors in patients with new onset type 2 diabetes after 5 years of intensive insulin treatment

作　　者：王叶[1] 杨历新[1] 米娜[1] 朱沁芳[2] 李金娟[2] 

机构地区：[1]青海省人民医院内分泌科,青海西宁810007 [2]苏州大学医学院,江苏苏州215000

出　　处：《中国现代医学杂志》2014年第9期102-105,共4页China Journal of Modern Medicine

基　　金：青海省科技项目计划基金(No:2009-Z-724)

摘　　要：目的探讨初发糖尿病患者胰岛素强化治疗追踪观察5年后胰岛功能及心血管危险因素变化状况,与口服降糖治疗患者对比观察。方法初发糖尿病住院患者随访未脱落者共59例,糖尿病宣教后随机分为胰岛素强化治疗组(28例)和口服药组(31例),糖尿病病程<6月,入院前未行任何药物治疗,治疗时记录体质量及腰围,行标准OGTT试验,同时测胰岛素及C-肽水平和舒张压、收缩压、血脂六项、C-反应蛋白及尿微量白蛋白等,彩超测定颈动脉中膜内膜厚度,计算胰岛素抵抗指数(HOMA-IR)。胰岛素泵14 d强化治疗后出院,门诊追踪观察的5年中,所有患者都被要求尽量控制血糖。5年时复查上述各项指标。结果初发糖尿病治疗前与治疗后5年对比,两组间的血糖、血压、HbA1c、BMI、血脂差异无显著性;INS组治疗5年后的CRP较基线水平降低,有显著性差异;且较OT组有明显差异;5年后INS组的IMT值较前下降,而OT组IMT值略有升高,有显著性差异;INS组与OT组有明显的差异;两组5年后胰岛素分泌指数HOMA-IR均较基线水平下降,组间无差异;胰岛素强化组5年后较口服药组HOMA-βcell水平高,有显著性差异。结论初发糖尿病胰岛素强化治疗后5年内心血管内皮炎性反应指标优于口服降糖药,且胰岛β细胞分泌功能恢复程度优于口服降糖药。[ Objective ] To explore the changes of β-cell function and cardiovascular risk factors in patients with onset diabetes after 5 years of intensive insulin treatment or oral drug. [Methods] According to individual compliance, 59 onset diabetes with complete data were divided into two groups： intensive insulin treatment group （n =28） and oral drug treatment group （n =31）. They did not receive any drug treatment before admission ,the following data recorded at the beginning of the treatment body weight ,waist circumference, standard OGTI＂ test, the level of insulin C-peptide, diastolic blood pressure, systolic blood pressure, blood lipids, C-reactive protein, intima-medial thickness, insulin resistance index （HOMA-IR）. After 14 days of intensive insulin treatment, each patient had been discharged and was asked well glucose control. Followed up for 5 years, all of the data were tested again. [ Results ] β-cell function in two groups was preserved at 5 years after diagnosis,better in INS group. CRP, IMT and 13 cells function were significantly changed in intensive insulin treatment patients with onset diabetes before and after 5years, and better than OT group. [ Conclusions ] After 5 years of intensive insulin treatment cardiovascular indicators of endothelial inflammatory response and the functional recovery of β-cell secretion were better than oral hypo- glycemic agents.

关 键 词：初发糖尿病 胰岛素强化治疗 心血管危险因子 

分 类 号：R587.1[医药卫生—内分泌]