血糖控制不佳的1型糖尿病患者短期应用实时动态胰岛素泵的疗效及安全性观察  

Efficacy and safety of short-term sensor-augmented insulin-pump therapy for poorly controlled patients with type 1 diabetes mellitus

作　　者：史春虹[1] 张丽莎[1] 白然[1] 刘丹[1] 王咏波[1] 王浩[1] 杨郁[1] 张雪扬[1] 季阳阳[1] 杜建玲[1] 

机构地区：[1]大连医科大学附属第一医院内分泌科,116011

出　　处：《中华全科医师杂志》2016年第2期118-122,共5页Chinese Journal of General Practitioners

基　　金：中华医学会临床医学科研专项资金项目（13040720457）

摘　　要：目的探讨血糖控制不佳的1型糖尿病患者短期应用实时动态胰岛素泵（SAP）的疗效及安全性。方法1型糖尿病患者60例，糖化血红蛋白（HbAlc）〉9．0％，随机分为SAP组及每日多次胰岛素皮下注射（MDI）组治疗6d。6d后SAP组转为MDI方案，1个月后随访。结果治疗6d后SAP组平均血糖（7．6±1．2）mmol／L、血糖标准差（SDBG）（1．9±0．8）mmol／L、日内平均血糖波动幅度（MAGE）（3．1±0．8）mmol／L及高血糖曲线下面积（AUC10.0）（2．2±0．3）mmol／L，与治疗前（12．4±2．1）mmo]／L、（3．2±0．5）mmo]／L、（5．0±1．2）mmol／L、（4．9±0．6）mmo]／L及MDI组治疗后（9．3±1．4）mmo]／L、（2．9±0．3）mmol／L、（4．8±0．7）mmol／L、（3．1±0．7）mmol／L比较均显著下降（与治疗前比较：t=3．128，P=0．006；t=2．689，P=0．024；t=2．966，P=0．013；t=3．076，P=0．009；与MDI组比较：t=1．761，P=0．028；t=2．569，P=0．037；t=2．712，P=0．020；t=2．985，P=0．014），低血糖曲线下面积（AUC3.9）差异无统计学意义（与治疗前比较，t=0．160，P=0．216；与MDI组比较，t=0．157，P=0．224）。1个月随访时SAP组HbAlc（9．5±1．0）％，与治疗前（10．2±1．1）％及MDI组（10．1±1．6）％比较，均显著下降（t=2．344，P=0．023；t=1．844，P=0．035）。每日胰岛素用量、空腹C肽（FCP）及餐后2hc肽（2hCP）与基线及MDI组比较差异无统计学意义（均P〉0．05）。年龄（t=2．125，P=0．012）、应用SAP方案（t=3．376，P=0．009）与随访时HbAlc水平下降幅度独立相关。结论与MDI比较，1型糖尿病患者应用SAP迅速降低血糖水平、减少血糖波动，不增加低血糖风险，短期应用也可持续获益。Objective To evaluate the efficacy and safety of short-term sensor-augmented insulin- pump （SAP） therapy for poorly controlled patients with type 1 diabetes mellitus （T1DM）. Methods Sixty T1DM patients with glycosylated hemoglobin （HbAlc） 〉 9.0% were randomly assigned to 2 groups treated with SAP or muhiple daily insulin injection （MDI） for 6 days, then all patients converted to MDI therapy. Results Compared with MDI group and before therapy, the mean blood glucose concentration （MBG） , SD of blood glucose, mean amplitude of glycemic excursion （ MAGE ） and 24-h area under curve at 10.0 （AUCl00） levels in SAP group significantly decreased after 6-day therapy （compared with MDI group： t = 1. 761 ,P = 0. 028, t = 2. 569, P = 0. 037, t = 2. 712, P = 0. 020, t = 2. 985, P = 0. 014, compared with before therapy ： t = 3. 128, P = 0. 006, t = 2. 689, P = 0. 024, t = 2. 966,P = 0. 013, t = 3. 076,P = 0. 009 ） ; while there was no difference in 24-h area under curve at 3.9 （AUC39 ） between groups （P 〉 0.05 ）. After 1 month follow-up HbAle levels decreased in SAP group （ t = 2. 344, P = 0. 023 ） and were significantly lower than those in MDI group （t = 1. 844, P = 0. 035 ）. There was no difference in daily insulin dosage, fasting C peptide （FCP） and postprandial 2 h C peptide （2 hCP） between two groups （P 〉 0.05 ）. Age （ t = 2. 125, P = 0. 012） and SAP therapy （ t = 3. 376, P = 0. 009 ） were independently correlated with the HbAlc after 1 month. Conclusion Short-term SAP therapy is effective and safe for poorly controlled T1DM patients with rapid glucose lowering and glycemic excursions reduction.

关 键 词：糖尿病 1型 胰岛素输注系统 持续血糖监测 治疗结果 

分 类 号：R587.1[医药卫生—内分泌]