阿卡波糖和二甲双胍对IGT人群糖尿病预防的效果——多中心3年前瞻性观察  

The preventive effect of Acarbose and Metformin on the IGT population from becoming diabetes mellitus: a 3-year multicentral prospective study

作　　者：杨文英[1] 林丽香[2] 齐今吾[3] 于志清[4] 裴海成[5] 何国芬[6] 杨兆军[1] 王芃[1] 李光伟 潘孝仁[1] 

机构地区：[1]中日友好医院内分泌科,北京100029 [2]福建省立医院内分泌科 [3]中国医科大学附属第一医院内分泌科 [4]广西医科大学附属第一医院内分泌科 [5]延边医学院附属医院内分泌科 [6]山西医学院附属医院内分泌科

出　　处：《中华内分泌代谢杂志》2001年第3期131-134,共4页Chinese Journal of Endocrinology and Metabolism

基　　金：国家九五攻关基金资助项目 (96 90 6 0 5 0 1)

摘　　要：目的　比较中国糖耐量低减 (IGT)人群药物干预与非药物干预对糖尿病发病率的作用。方法　对以口服 75克葡萄糖耐量试验 (OGTT)筛查 ,按 1985年WHO诊断标准判定的IGT 32 1例 (年龄>2 5岁 )进行 3年前瞻性研究。初访时按区域分成对照组、饮食加运动组、阿卡波糖 (拜唐苹 )组和二甲双胍组 ,每年进行OGTT复查 ,同时空腹状态测量身高、体重、血压、血脂等。对照组除进行一般糖尿病防治知识宣教外 ,不进行强化教育 ;饮食加运动组按个体情况安排饮食及运动方案 ,每年重复宣教饮食及运动的治疗意义 ;药物干预组每月定期发放口服药物 ,剂量为阿卡波糖 5 0mg每日 3次 ,二甲双胍 0 .2 5g每日 3次。结果　初访时 4组基线资料无统计学差异 ,3年末 ,对照组空腹血糖(FPG)及OGTT后 2小时血糖 (2hPG)均有上升 ,平均每年糖尿病发病率为 11.6 % ;饮食加运动组FPG轻度升高 ,但 2hPG轻度下降 ,平均每年糖尿病的发病率为 8.2 % ;阿卡波糖组和二甲双胍组FPG及2hPG均有显著下降 ,每年糖尿病发病率分别为 2 .0 %和 4.1%。药物组 3年末平均FPG与对照组、饮食加运动组比较差异有显著性。多因素比例风险模型回归分析显示基线 2hPG、体重指数与糖尿病呈独立正相关 ,阿卡波糖和二甲双胍组治疗与糖尿病发生呈独立负相关。结论　本研究?Objective To assess the effect of pharmacological and non pharmacological interventions on Chinese subjects with impaired glucose tolerance (IGT). Methods In this 3 year prospective study, 321 subjects aged above 25 years with IGT were included. IGT was defined by 1985 WHO criteria utilizing a 75 g oral glucose tolerance test (OGTT). The subjects were divided into control (C), diet plus exercise (D+E), Acarbose (Glucobay, A) and Metformin (M) groups. The subjects in the group D+E underwent an individually designed diet and exercise program, the importance of which was reiterated annually. The group C only received conventional education on diabetes prevention. The two pharmacological groups were orally given Acarbose (50 mg, t.i.d) and Metformin (0.25 g, t.i.d) respectively. OGTT, weight, height, blood pressure, lipids were measured yearly during the follow up. The t test, Chi square test and proportional hazard regression analysis were used to analyze the risk reduction in diabetes conversion from each group. Results The baseline data of 4 groups had no statistical differences. By the end of study, both the fasting plasma glucose (FPG) and the 2h postprandial plasma glucose (2hPG) in group C elevated (FPG from 6.02 mmol/L to 6.59 mmol/L, 2hPG from 8.83 mmol/L to 9.13 mmol/L), and the annual diabetes incidence was 11.6%. The corresponding changes in group D+E were FPG from 6.11 mmol/L to 6.21 mmol/L, PG2h from 9.28 mmol/L to 8.98 mmol/L, and 8.2% of annual diabetes incidence. In contrast, both the FPGandthe2hPG significantly decreased in group A (FPG from 6.03 mmol/L to 5.47 mmol/L, 2hPG from 8.34 mmol/L to 7.21 mmol/L)andingroup M (FPG from 6.01 mmol/L to 5.85 mmol/L, 2hPG from 9.05 mmol/L to 7.92 mmol/L). Theannualdiabetesincidencedecreasedto2.0% in group A, and 4.1% in group M. Proportional hazard regression analysis showd that the annual diabetes incidence was positively correlated with the baseline 2hPG and body mass index (OR=1.33, P=0.006 and OR=1.11, P=0.008, respectively), and negatively correla

关 键 词：葡糖耐受不良 糖尿病 干预性研究 二甲双胍 阿卡波糖 

分 类 号：R587.1[医药卫生—内分泌] R977.15[医药卫生—内科学]