早期胰岛素强化治疗期间的血糖水平可预测血糖缓解  

Blood glucose levels during early intensive insulin therapy predict glycemic remission

作　　者：王良娇 刘烈华[1] 刘娟[1] 万学思[1] 柯伟健[1] 邓婉萍[1] 李延兵[1] 

机构地区：[1]中山大学附属第一医院内分泌科,广州510080

出　　处：《中华糖尿病杂志》2016年第12期717-722,共6页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：基金项目：教育部博士点基金（20130171110067）;广东省自然科学基金（2016A030313252）;广东省第一批产业技术研究与开发资金计划项目（2012A030400006）;广州市科技惠民专项基金（2014Y2-00127）;公益性行业科研专项（201502007）

摘　　要：目的通过分析新诊断2型糖尿病（T2DM）患者短期胰岛素强化治疗期间的全天血糖谱，探讨达标期间血糖水平与血糖缓解的关系。 方法本研究回顾了2001至2014年中山大学附属第一医院内分泌科进行短期胰岛素泵强化治疗的266例新诊断T2DM患者。所有患者均在诊断后入院接受2~3周胰岛素强化治疗，并在治疗后接受了1年以上的长期随访。根据治疗后即刻能否缓解，分为即刻缓解组（187例，男127例，女60例）与即刻非缓解组（79例，男47例，女32例）。根据随访1年是否缓解，分为长期缓解组（127例，男89例，女38例）与非缓解组（139例，男85例，女54例）。记录患者在达标期间的血糖数据，并分析血糖控制水平、血糖水平的标准差与血糖缓解的关系。两组间比较采用t检验，采用Logistic回归方程、Cox回归方程进行血糖缓解影响因素的分析。 结果总体患者达标期间平均血糖为（6.2±0.6）mmol/L。停泵后即刻缓解率为70.3%（187/266），1年缓解率为47.7%（127/266）。即刻血糖缓解组平均血糖低于即刻非缓解组[（6.1±0.6）比（6.6±0.7） mmol/L，t=6.026，P〈0.05]。多因素回归分析示达标期间平均血糖每升高1 mmol/L，即刻血糖缓解率减少65%（OR=0.350，95%CI：0.192~0.638，P〈0.05）。1年血糖缓解组达标期间的平均血糖比非缓组更低[（6.0±0.5）比（6.5±0.7） mmol/L，t=6.147，P〈0.05]。多因素回归分析示达标期间平均血糖是1年缓解的预测因子（OR=0.388，95%CI：0.224~0.670，P〈0.05）。达标期间平均血糖每升高1 mmol/L，1年内高血糖复发风险增加0.814倍（HR= 1.814, 95%CI：1.333~2.469，P〈0.05）。如以平均空腹血糖和平均餐后2 h血糖代替平均血糖进行分析，则仅平均餐后2 h血糖（OR=0.530，95%CI：0.368~0.753，P〈0.05）是1年血糖缓解的独立预测因素。 结论短期胰岛素强化治疗期间，血糖控制更严格的�ObjectiveTo investigate blood glucose profiles of patients with type 2 diabetes mellitus during short-term intensive insulin therapy and to analyze the relationship between blood glucose levels and glycemic remission. MethodsA total of 266 patients with newly diagnosed type 2 diabetes who accepted short-term insulin pump therapy in the Department of Endocrinology in the First Affiliated Hospital of Sun Yat-sen University during 2001 to 2014 were included in this study. All patients accepted 2- 3 weeks of short-term insulin pump therapy after diagnosis. They were followed-up for 1 year after the cessation of the pump. Subjects were divided into instant remission group （187 patients, 127 men and 60 women） and instant non-remission group（79 patients, 47 men and 32 women） according to whether they could be relieved immediately after the treatment. According to the follow-up one year, subjects were divided into long-term remission group （127 patients, 89 men and 38 women） and non-remission group（139 patients, 85 men and 54 women）. The capillary blood glucose profiles were recorded, relationship between blood glucose levels, standard deviation of blood glucose level and glycemic remission was analyzed. Difference between two groups was analyzed by t test. Logistics regression analysis and Cox regression analysis were used to analyze the influencing factors of glycemic remission. ResultsMean blood glucose （MBG） after achieving glycemic targets was （6.2±0.6） mmol/L in all subjects. Instant glycemic remission rate after the cessation of the pump was 70.3% （187/266）, one year remission rate was 47.7% （127/266）. Compared with instant non-remission group, MBG was lower in instant remission group [（6.1±0.6）vs （6.6±0.7） mmol/L, t= 6.026, P〈0.05]. Multivariate logistics regression analysis showed that immediate glycemic remission rate was reduced by 65% （OR=0.350, 95% CI：0.192- 0.638, P〈0.05） for every 1 mmol/L increase in MBG. Compared with non-remission group, MBG was

关 键 词：糖尿病 2型 血糖 胰岛素泵 血糖缓解 

分 类 号：R587.1[医药卫生—内分泌]