新诊断2型糖尿病患者胰岛素泵强化治疗后长期白蛋白尿发生风险的回顾性研究  

A retrospective study on the risk of long-term albuminuria in newly diagnosed type 2 diabetic patients after continuous subcutaneous insulin infusion therapy

作　　者：和瑞婷 吕肖锋[2] 武晋晓[2] 向莎[2] 赵田[2] 张天瀛[2] 

机构地区：[1]山西医科大学第二临床医学院内分泌科,太原030001 [2]北京军区总医院内分泌科

出　　处：《中国糖尿病杂志》2016年第3期210-213,共4页Chinese Journal of Diabetes

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新诊断T2DM患者长期白蛋白尿发生风险的影响。方法收集2000年1月至2008年1月于北京军区总医院内分泌科住院的新诊断T2DM患者583例,按住院期间治疗方式分为胰岛素泵强化治疗（CSII）组275例和口服药物降糖治疗（OHA）组308例。于2014年1月至2015年6月进行随访,复查糖尿病及其并发症相关指标。比较两组白蛋白尿发生率及尿白蛋白/肌酐（UAlb/Cr）。按UAlb/Cr采取分层抽样法从两组各抽出60例行72 h动态血糖监测（CGMS）,比较两组间血糖波动参数,并探讨UAlb/Cr与血糖波动的相关性。结果随访时,两组BMI、BP、TG、TC、LDL-C、HbA1c比较,差异无统计学意义（P〉0.05）;CSII组UAlb/Cr水平低于OHA组（P〈0.05）。随访时,CSII组UAlb/Cr 30~299 mg/24 h和UAlb/Cr≥300 mg/24h发生率均低于OHA组（P〈0.05）;CSII组日内平均血糖波动幅度（MAGE）、全天血糖标准差（SDBG）、平均餐后血糖波动幅度（MP—PGE）及最大血糖波动幅度（LAGE）均低于OHA组（P〈0.05）。Pearson相关分析表明,UAlb/Cr水平与MAGE、SDBG、MPPGE、LAGE呈正相关（r=0.227、0.103、0.326、0.156,P〈0.05）。多元逐步回归分析显示,病程、SBP、TG、MAGE是UAlb/Cr的影响因素。结论早期胰岛素泵强化治疗可降低新诊断T2DM患者长期白蛋白尿的发生风险,血糖波动可能参与其中。Objective To investigate the effect of early continuous subcutaneous insulin infusion（CSID therapy on the risk of long-term albuminuria in newly diagnosed type 2 diabetic patients.Methods A total of 583 newly diagnosed T2 DM patients hospitalized in the department of endocrinology of Beijing general military hospital from January 2000 to January 2008 were selected and divided into two groups according to their treatment during hospitalization：continuous subcutaneous insulin infusion treatment group（CSII group,n= 275） and oral hypoglycemic agents treatment group（OHA group,n = 308）.All patients were followed up from January 2014 to June 2015 to re-evaluate their disease status and relevant indicators for the complications.Albuminuria incidence and urinary albumin/creatinine ratio（UAlb/Cr）were compared between two groups.Sixty patients from each group were selected by stratified sampling methods according to UAlb/Cr level to take continuous glucose monitoring system（CGMS）.Indicators for blood glucose fluctuation were compared between two groups and correlation between UAlb/Cr and blood glucose fluctuation was investigated.Results There were no significant differences in BMI,BP,HbA1 c,TG,TC and LDL-C between two groups at the follow-up visit（P〉0.05）.UAlb/Cr level and the incidences of 30~299 mg/24 h and ≥300 mg/24 h were lower in CSII group than in OHA group（P〈0.05）.The levels of mean amplitude of glycemic excursions（MAGE）.standard deviation of blood glucose（SDBG）,mean postprandial glucose excursion（MPPGE） and largest amplitude of glycemic excursion（LAGE） were also significantly lower in CSII group than in OHA group（P〈0.05）.Pearson correlation analysis showed that UAlb/Cr level was positively correlated with MAGE,SDBG,MPPGE and LAGE（r=0.227,0.103,0.326,0.156,P〈0.05）.Multiple stepwise regression analysis showed that course,SBP,TG and MAGE were independent risk factors for UAlb/Cr level.Conclusion Early continuous subcutaneous insulin infusion（CSII） ther

关 键 词：糖尿病 2型 持续皮下胰岛素输注 尿白蛋白/肌酐 血糖波动 

分 类 号：R587.1[医药卫生—内分泌]