应用糖皮质激素的糖尿病患者胰岛素治疗方案探讨  

Exploration of insulin regimen in diabetic patients taking glucocorticoid

作　　者：陈贵言[1] 赵婷[1] 胡晓艳[1] 高秀兰[1] 

机构地区：[1]滨州市人民医院内分泌科,256600

出　　处：《中国糖尿病杂志》2017年第5期407-410,共4页Chinese Journal of Diabetes

摘　　要：目的探讨应用糖皮质激素糖尿病患者的临床特点及胰岛素治疗。方法选取应用中效糖皮质激素并于清晨1次给药的糖尿病患者60例,随机分为预混人胰岛素(30R)治疗组(30R组)、3次门冬胰岛素+1次重组甘精胰岛素治疗组(3+1IN组)两组。30R组予精蛋白生物合成人胰岛素30R早、中餐前皮下注射治疗;3+1IN组予门冬胰岛素3餐前加重组甘精胰岛素睡前皮下注射治疗。结果各组治疗后各时刻血糖均较治疗前好转(P<0.01);30R组3餐后2 h、睡前、02:00血糖与3+1IN组比较,差异无统计学意义(P>0.05);与3+1IN组比较,30R组FPG升高[(4.8±0.6)vs(6.0±0.9)mmol/L,P<0.05];中、晚餐前血糖降低[(8.7±1.3)vs(7.1±1.0)mmol/L,(10.2±1.7)vs(7.4±1.2)mmol/L,P<0.05]。结论预混人胰岛素30R早、中餐前皮下注射治疗应用糖皮质激素清晨1次给药的糖尿病患者有较好的临床疗效,且方案简单,值得推广。Objective To explore the clinical characteristics and insulin regimen in diabetic patients taking glueocortieoid. Methods A total of 60 patients with diabetes taking intermediate acting glucocorticoid in the morning were enrolled in this study and randomly divided into two groups, premixed human insulin treatment group （30R group） and insulin aspart 3 times/d combined with recombinant insulin glargine 1 time/d group （3 ＋ IIN group）. 30R group was treated with isophane protamine biosynthetic human insulin （pre-mixed 30R） subcutaneous injection before breakfast and lunch. 3 ＋ IIN group was treated with insulin aspart subcutaneous injection before three meals and recombinant insulin glargine subcutaneous injection before bedtime. Results After treatment, the plasma glucose of each time point was significantly improved in both groups （P〈0.01）. There were no statistically differences of the 2-hour postprandial plasma glucose（2 hPG） after three meals, bedtime plasma glucose （BTPG）, and midnight plasma glucose （02.. 00 PG） between the two groups （P〉0. 05）. The fasting plasma glucose （FPG） was higher[（6.0±0.9）vs（4.8±0.6） mmol/L,P〈0. 05],while the plasma glucose before lunch and dinner was lower [-（7.1±1.0）vs（8.7±1.3） mmol/L, （7.44-1.2）vs（10.2＋1.7） mmol/L,P〈0. 05] in 30R group than in 3＋IIN group. Conclusion Subcutaneous injection of isophane protamine biosynthetic human insulin （pre-mixed 30R） before breakfast and lunch is effective in clinical practice and worth of generalized in diabetic patients taking intermediate acting glucocorticoid in the morning.

关 键 词：糖皮质激素 糖尿病 胰岛素 治疗 

分 类 号：R587.1[医药卫生—内分泌]