以动态血糖监测系统监测二肽基肽酶Ⅳ抑制剂对脆性糖尿病患者血糖波动影响  

Effect of dipeptidyl peptidase Ⅳ inhibitor on blood glucose fluctuation in patients with brittle diabetes mellitus by dynamic blood glucose monitoring system

作　　者：李征寒[1] 徐滨华[1] 王晶[1] 王葳[1] 

机构地区：[1]哈尔滨市第一医院内分泌科,黑龙江哈尔滨150010

出　　处：《中国医药导报》2017年第30期70-73,84,共5页China Medical Herald

摘　　要：目的观察二肽基肽酶Ⅳ(DPP-4)抑制剂联合胰岛素四次强化对脆性糖尿病患者血糖波动的影响。方法选取2013年5月~2016年10月哈尔滨市第一医院门诊及住院的脆性糖尿病患者72例,所有患者给予胰岛素四次强化(门冬胰岛素/赖脯胰岛素+甘精胰岛素/地特胰岛素)治疗并采用CGMS连续监测血糖3 d,3 d后依据随机数字表法分为DPP-4组和对照组,每组36例。对照组继续应用上述降糖方案,DPP-4组则在此基础上加用沙格列汀5 mg/d,分组前、分组后1~3 d及分组后13~15 d亦以CGMS连续监测血糖。比较两组血糖波动[平均血糖波动幅度(MAGE)、血糖水平标准差(SDBG)、最大血糖波动幅度(LAGE)、平均血糖水平(MBG)、血糖>10.0 mmol/L的时间百分率(PT10.0)、血糖<3.9 mmol/L时间百分率(PT3.9)]、胰岛素用量以及基础C肽(FC-P)水平。结果组内比较:DPP-4组分组后1~3 d的MAGE、MBG、LAGE、PT10.0、PT3.9均较分组前降低(P<0.05),分组后13~15 d各项血糖波动指标均较分组前明显降低(P<0.01);对照组分组后1~3 d各项血糖波动指标较分组前差异无统计学意义(P>0.05),分组后13~15 d的MBG、LAGE、PT10.0较分组前降低(P<0.05)。组间比较:分组后1~3 d,DPP-4组MAGE、LAGE、PT10.0较对照组降低(P<0.05);分组后13~15 d,DPP-4组各项血糖波动指标均较对照组显著降低(P<0.05或P<0.01)。DPP-4组分组后15 d胰岛素用量均较分组前明显减少(P<0.01);两组分组后15 d胰岛素用量比较差异有高度统计学意义(P<0.01);两组分组前后FC-P组间及组内比较差异无统计学意义(P>0.05)。结论沙格列汀联合胰岛素四次强化可改善脆性糖尿病患者的血糖波动。Objective To observe the effect of dipeptidyl peptidase Ⅳ （DPP-4） inhibitor on blood glucose fluctuation in patients with brittle diabetes mellitus by dynamic blood glucose monitoring system. Methods 72 cases of outpatient and hospitalized patients with brittle diabetes from May 2013 to October 2016 in the First Hospital of Harbin City were selected, all patients enrolled after giving four intensive insulin （Insulin Aspart/Insulin Lispro ＋ Glargine Insulin/Insulin Detemir） treatment, then continuously monitored the blood glucose of the patients with CGMS for 3 days. After 3 days, the patients were divided into DPP-4 group and control group by random number table method, each group of 36 cases. The above hypoglycemic scheme was continued to use in control group, Shah Glenn Dean 5 mg/d was used in DPP-4 group on the basis of control group. All patients were continuously monitored with CGMS before grouping, 1-3 days after grouping and 13-15 days after grouping. Blood glucose fluctuation [mean blood glucose fluctuation range （MAGE）, standard deviation of blood glucose level （SDBG）, maximum blood glucose fluctuation range （LAGE）, mean blood glu- cose level （MBG）, blood glucose〉 10.0 mmol/L time percentage （PT10.0）, blood glucose 〈3.9 mmol/L time percentage （PT3.9）], the amount of insulin and C peptide level between two groups were compared. Results Intra-group comparison： after grouping of 1-3 d, MAGE, MBG, LAGE, PT10.0 and PT3.9 of DPP-4 group were lower than before grouping （P 〈 0.05）; after grouping of 13-15 d, the indicators of blood glucose fluctuations in DPP-4 group were lower than before grouping （P 〈 0.01）; there were no significant differences on blood glucose fluctuation indexes before grouping and after grouping of 1-3 d in control group （P 〉 0.05）; after grouping of 13-15 d, MBG, LAGE, PT10.0 in control group were lower than before grouping （P 〈 0.05）. Comparison among groups： after grouping of 1-3 d, MAGE, LAGE, PT10.0 of DPP-4 group wer

关 键 词：二肽基肽酶Ⅳ抑制剂 动态血糖监测系统 血糖波动 脆性糖尿病 

分 类 号：R587.1[医药卫生—内分泌]