胰岛素联合维格列汀治疗2型糖尿病合并中度肾损伤患者的有效性和安全性  

Efficacy and safety of insulin combined with vildagliptin in the treatment of type 2 diabetic patients with moderate renal impairment

作　　者：单春艳[1] 孔岩[1] 殷明亮 苗克新 侯方 杨菊红[1] 任惠珠[1] 王颖[1] 郑妙艳[1] 常宝成[1] 陈莉明[1] 

机构地区：[1]天津医科大学代谢病医院糖尿病肾病科 卫生部激素与发育重点实验室,300070 [2]天津滨海新区解放路社区卫生服务中心

出　　处：《中华糖尿病杂志》2014年第5期321-324,共4页CHINESE JOURNAL OF DIABETES MELLITUS

摘　　要：选取2012年12月至2013年11月于天津医科大学代谢病医院和天津滨海新区解放路社区卫生服务中心门诊或住院治疗的胰岛素治疗且血糖控制不佳的中度肾损伤的2型糖尿病（T2DM）患者143例,在现有胰岛素不变的基础上加用维格列汀50 mg每日1次口服治疗12周.比较治疗前后糖化血红蛋白（HbA1c）、空腹血糖（FPG）、预估肾小球滤过率（eGFR）、血红蛋白（Hb）和胰岛素用量变化情况,评估用药后的不良事件以及患者和医师的满意度.132例患者完成12周维格列汀药物治疗.与治疗前相比,治疗后HbA1c降低0.7％,FPG降低了1.8 mmol/L,胰岛素用量减少了8.0U,治疗前后差异具有统计学意义[分别为：（8.4±0.8）％比（7.7±1.2）％,=7.515;（10.6±2.6）比（8.8±1.4） mmol/L,t =9.476;（51 ±16）比（43±15） U/d,t=4.421;均P＜0.05];Hb和eGFR治疗前后无差异（均P ＞0.05）.治疗中无胰腺炎、死亡等严重不良事件的发生.医师对于中度肾损伤患者应用维格列汀治疗的满意度达94.7％,患者自身的满意度为94.0％.胰岛素联合维格列汀50 mg每日1次可改善中度肾损伤患者的血糖水平,同时具有良好的耐受性和安全性.To evaluate the efficacy and safety of insulin combined with vildagliptin in type 2 diabetes mellitus （T2DM） patients with moderate renal impairment.A total of 143 T2DM patients with moderate renal impairment and poorly controlled blood glucose were included from December 2012 to November 2013 in outpatients or in patients of the Metabolic Disease Hospital of Tianjin Medical University and Jiefang Road Health Service Center,Binhai New District,Tianjin.On the basis of their existing insulin therapy,vildagliptin （50 mg once daily） was added to these patients for 12 weeks.Hemoglobin A1c （HbA1c）,fasting plasma glucose （FPG）,estimated glomerular filtration rate （eGFR）,hemoglobin （Hb） and insulin dosage from baseline to week 12 were compared and adverse events and satisfaction of patients and doctors were assessed.132 patients completed this study.After the treatment,the levels of HbA1c in patients with moderate renal impairment were decreased by an average of 0.7% （（8.4 ±0.8）% vs （7.7 ± 1.2）%,t =7.515）,FPG decreased 1.8 mmol/L （（10.6 ± 2.6） vs （8.8 ± 1.4） mmol/L,t =9.476） and insulin dosage lowered 8 U （（51 ± 16） vs （43 ± 15） U/d,t =4.421,all above P 〈 0.05）.Hb and eGFR were not changed after treatment （P 〉 0.05 all above）.During the study,there was no occurrence of pancreatitis,death and other serious adverse effect.The satisfactions with vildagliptin treatment in patients with moderate renal impairment were 94.7% for physician,while were 94.0% for patients themselves.Vildagliptin 50 mg once daily is a well-tolerance and safety treatment option for patients with inadequately controlled T2DM and moderate blood glucose level in moderate renal impairment patients.

关 键 词：糖尿病 2型 胰岛素 维格列汀 肾功能不全 中度 DIABETES mellitus type 2 

分 类 号：R587.1[医药卫生—内分泌]