新诊断2型糖尿病早期胰岛素强化治疗后三种治疗方案对胰岛β细胞功能及胰岛素抵抗的影响  

Effect of different treatment on pancreatic β-cell function and insulin resistance after initial intensive insulin therapy in newly diagnosed type 2 diabetes

作　　者：杨彩娴[1] 黄启亚[1] 钟国权[1] 李绍清[1] 穆攀伟[2] 梁俊兴[1] 贾文娟[1] 曾龙驿[2] 

机构地区：[1]广东省清远市人民医院内分泌科,511518 [2]中山大学附属第三医院内分泌科

出　　处：《中华糖尿病杂志》2016年第10期613-617,共5页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：广东省医学科研基金项目（A2013808）

摘　　要：目的探讨新诊断2型糖尿病胰岛素早期强化治疗后采用三种治疗方案对患者β细胞功能及胰岛素抵抗的影响。方法选取2014年1月至12月清远市人民医院内分泌科就诊的125例新诊断2型糖尿病患者为研究对象，给予胰岛素强化治疗加二甲双胍口服，血糖达标[空腹血糖（FPG）维持在4．4～6．1mmol／L，餐后2h血糖维持在〈8mmol／L]后采用随机数字表法分为3组：A组：基础胰岛素类似物组44例，B组：预混胰岛素类似物组39例，C组：磺脲类促胰岛素分泌剂组42例，治疗3个月。治疗前后检测体质指数、FPG、糖化血红蛋白、血脂、静脉葡萄糖耐量试验C肽水平。计算急性胰岛素分泌反应、静脉葡萄糖耐量试验中C肽曲线下面积、稳态模型B细胞功能指数（HOMA-β）及稳态模型胰岛素抵抗指数（HOMA-IR）。两组间比较用t检验，多组间均数比较采用方差分析。各变量间关系采用相关分析，非线性关系变量经转换为直线关系后进行线性回归分析。结果经治疗后A、B、C组HOMA-β较治疗前明显上升（分别为9．7±1．4比2.3±1．2、10．0±1．7比2．7±1．3、7.3±1．8比2．3±1．4，F=28．620，均P〈0．01），HOMA-IR明显下降（0．28±0．16比0．48±0．33、0．28±0．13比0．40±0．23、0．24±0．12比0．39±0．23，F=39．162，均P〈0．01）。A、B组的HOMA-β改善与C组比较差异有统计学意义（分别为9．7±1．4比7．3＋1．8．t=-3．23，10．0±1．7比7．3±1．8，t=2．53，均P〈0．01）。结论对新诊断的2型糖尿病患者早期胰岛素强化治疗后优先选择包含胰岛素的治疗方案胰岛B细胞功能改善更明显。Objective To explore the effects of different treatment on pancreatic β-cell function and insulin resistance after initial intensive insulin therapy in newly diagnosed type 2 diabetes. Methods One hundred and twenty five newly diagnosed type 2 diabetes patients were enrolled as the subjects from January 2014 to December 2014 in Department of Endocrinology, the People＇s Hospital of Qingyuan city. These patients were administered with 14 days of continuous subcutaneous insulin infusion with metformin. After the blood sugar reached the standard levels（fasting blood glucose：4.4-6.1 mmol/L and 2 h postprandial blood glucose〈8 mmol/L）, these patients were randomized divided into the three subsequent treatment groups for 3 months follow-up treatment through the random number table： group A （44 patients）： basal insulin analogues; group B（39 patients）： premixed insulin analogues; group C（42 patients）： sulfonylureas insulin seeretagogue. The body mass index（BMI）, fasting plasma glucose （FPG）, glyeosylated hemoglobin （HbAtc）, lipids were measured in each group before and after treatment, and the different time＇s blood C-peptide levels were measured during intravenous glucose tolerance test. Acute insulin response （AIR）,C-peptide area under curve, homeostasis model assessment for β cell function （HOMA-β）, homeostasis model assessment-insulin resistance（HOMA-IR） were calculated. The least significant difference t-test and one-way ANONA were used to analyze the quantitative variables between groups. Correlation analysis was used test the relationship among variables. Results The HOMA-β significant improved （9.7 ± 1.4 vs 2.3 ± 1.2, 10.0± 1.7 vs 2.7± 1.3, 7.3 ± 1.8 vs 2.3 ± 1.4, F=28.620, all P〈0.01）, HOMA-IR（0.28±0.16 vs 0.48±0.33, 0.28±0.13 vs 0.40±0.23, 0.24±0.12 vs 0.39±0.23, F=39.162, all P〈0.01） was decreased in each group. HOMA-13 in group A and group B were significantly different from that in Group C （9.7 ± 1.4 vs 7.3 ± 1.8, t=-3.23,

关 键 词：糖尿病 2型 早期强化治疗 后续治疗 Β细胞功能 胰岛素抵抗 

分 类 号：R587.1[医药卫生—内分泌]