胰岛素泵强化治疗对2型糖尿病合并冠心病患者血糖波动、内皮脂肪酶及超敏C反应蛋白的影响  

Influence of Intensive Insulin Pump Treatment on Blood Sugar Fluctuation and the Levels of Endothelial Lipase and High Sensitive C-reactive Protein in Type 2 Diabetic Patients with Coronary Heart Disease

作　　者：丁林[1,2] 吕肖锋[1] 张星光[1] 赵大坤[1] 马艳霞[1] 彭永[1] 王亚双[1] 

机构地区：[1]北京军区总医院内分泌科,北京100700 [2]安徽医科大学研究生学院,合肥230032

出　　处：《解放军医药杂志》2014年第8期33-36,共4页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

基　　金：国家科技重大专项子课题(2011ZX09307-001-08)

摘　　要：目的：观察胰岛素泵强化治疗对2型糖尿病（ T2DM）合并冠心病患者血糖波动及血清内皮脂肪酶（ EL）、超敏C反应蛋白（ hs-CRP）的影响。方法选择2013年6月-2014年3月在北京军区总医院内分泌科住院的T2DM合并冠心病患者60例。入院当天行72 h动态血糖监测（CGM）,并予胰岛素泵皮下持续输注强化治疗10~14 d,血糖控制平稳后再次行CGM,比较治疗前后日内平均血糖波动幅度（ MAGE）、全天血糖标准差（ SDBG）、最大血糖波动幅度（ LAGE）；治疗前后测量患者身高、体重计算体重指数（ BMI）,空腹采集患者静脉血检测空腹血糖（ FPG）、餐后2 h血糖（2 h PG）、糖化血红蛋白（HbA1c）、hs-CRP及EL,计算胰岛素抵抗指数（HOMA-IR）；分析治疗前EL水平与其他指标的相关性。结果与治疗前比较,本组治疗后HOMA-IR、EL、hs-CRP、MAGE、SDBG、LAGE均显著降低（P〈0.05,P〈0.01）；Pearson相关分析显示,治疗前EL水平与hs-CRP、MAGE水平呈显著正相关（r=0.517、0.428, P〈0.01）。结论对T2DM合并冠心病患者予胰岛素泵强化治疗不仅可降糖、控制血糖波动,还能抗炎、抗动脉粥样硬化,对糖尿病大血管并发症的防治起到重要作用。Objective To observe the influence of intensive insulin pump treatment on levels of mean amplitude of glycemic excursions （ MAGE） , serum endothelial lipase （ EL） and high sensitive C-reactive protein （ hs-CRP） in type 2 diabetic （T2DM） patients with coronary heart disease. Methods Sixty patients with T2DM complicated with coronary heart disease during June 2013 and March 2014 were selected. All the patients were given the continuous glucose monito-ring （ CGM） for 72 h, and then the intensive insulin pump treatment was given for 10 - 14 d. The CGM for 72 h was performed again after the level of blood sugar remained stable, and the levels of mean amplitude of glycemic excursions （MAGE）, standard deviation of blood glucose （SDBG） and largest amplitude of glycemic excursions （LAGE） before and after the treatment were compared. The indexes levels of height, weight, body mass index （BMI）, fasting plasma glucose （FPG）, two-hour plasma glucose （2 h PG）, glycated hemoglobin （HbA1c）, high sensitive C reactive protein （ hs-CRP） , endothelial lipase （ EL） and insulin resistance index （ HOMA-IR） before and after treatment were detected;the correlation between EL level and other indexes before the treatment was also analyzed. Results Compared with those before treatment, the levels of HOMA-IR, EL, hs-CRP, MAGE, SDBG and LAGE were significantly reduced （ P 〈0. 05, P〈0. 01）;Pearson correlation analysis showed that before the treatment the serum EL level was positively correla-ted with hs-CRP and MAGE levels （r=0. 517, 0. 428, P〈0. 01）. Conclusion Intensive insulin pump treatment for T2DM patients with coronary heart disease may not only reduce blood sugar level and control blood sugar fluctuation, but also play an important role of anti-inflammation and anti-atherosclerosis, which is important to prevent diabetic large ves-sels complication.

关 键 词：糖尿病 2型 冠心病 胰岛素输注系统 内皮脂肪酶 血糖波动 

分 类 号：R587.1[医药卫生—内分泌] R541.4[医药卫生—内科学]