肥胖合并高胰岛素血症的综合治疗效果观察  

Study on the comprehensive treatment of obesity with hyperinsulinemia and observation of effect

作　　者：张卫欢[1] 郭智慧 李秋云[1] 王倩[1] 周艳茹 ZHANG Weihuan;GUO Zhihui;LI Qiuyun;WANG Qian;ZHOU Yanru(Department of Endocrinology,Kailuan General Hospital,Tangshan,Hebei 063000,China)

机构地区：[1]开滦总医院内分泌二科,河北唐山063000

出　　处：《安徽医药》2020年第11期2153-2156,共4页Anhui Medical and Pharmaceutical Journal

基　　金：河北省卫生计生委支撑项目(20160758)。

摘　　要：目的探讨肥胖合并高胰岛素血症病人的综合治疗措施,并观察其效果。方法选取2017年3月至2018年11月开滦总医院收治的肥胖合并高胰岛素血症病人92例,利用计算机软件生成的随机数表分为两组,对照组仅给予基础治疗,包括饮食、运动疗法和芬特明口服,观察组在上述疗法的基础上给予口服奥利司他、二甲双胍和胃旁路手术治疗。比较两组治疗前、3个月、6个月后体质量指数(BMI)、空腹血糖(FPG)、空腹胰岛素(FINS)、胰岛素抵抗指数(IR)水平变化,比较两种方案对肥胖的疗效、对高胰岛素血症的疗效,病人满意度,分析安全性。结果两组BMI、FPG、FINS、IR组间、时间、交互对比均差异有统计学意义(P<0.05),两组BMI、FPG、FINS和IR均随着时间的延长下降(P<0.05),且观察组治疗3个月、6个月后BMI、FPG、FINS和IR均低于对照组(P<0.05);两组对肥胖的疗效、对高胰岛素血症的疗效分布比较,均差异有统计学意义(P<0.05),观察组对肥胖的总有效率93.48%和对高胰岛素血症的总有效率95.65%均高于对照组73.91%和78.26%(P<0.05);观察组病人对治疗方案操作(91.30%比69.57%)、有效性(93.48%比67.36%)、舒适度的满意率(97.83%比69.57%)均高于对照组(P<0.05);对照组未见副作用,观察组有1例低血糖、未见术后并发症,两组对比差异无统计学意义(P>0.05)。结论对肥胖合并高胰岛素血症病人在饮食、运动疗法和基础药物治疗的同时给予专科药物和手术治疗可降低BMI、FPG、FINS和IR,控制肥胖、降低高胰岛素血症,提高病人满意率,安全可靠。Objective To study the comprehensive treatment of obesity patients with hyperinsulinemia and to observe its effect.Methods Ninety-two obese patients with hyperinsulinemia were divided into two groups in Kailuan General Hospital from March 2017 to November 2018.The basic group was only given basic treatment,including diet,exercise therapy and phentermine.On the basis of the above treatment,the study group was given orlistat,metformin and surgical treatment.The changes of body mass index(BMI),fasting blood glucose(FPG),fasting insulin(FINS)and insulin resistance index(IR)were compared before,3 months and 6 months after treatment.The effect of two schemes on obesity,hyperinsulinemia and patient satisfaction were compared.The safety was analyzed.Results There were significant differences in BMI,FPG,FINS,IR,time and interaction between the two groups(P<0.05).BMI,FPG,FINS and IR in the two groups decreased with the prolongation of time(P<0.05),and BMI,FPG,FINS and IR in the study group were lower than those in the basic group after 3 months and 6 months of treatment(P<0.05).There were significant differences in the efficacy of obesity and hyperinsulinemia between the two groups(P<0.05).The total effective rates of obesity(93.48%vs.73.91%)and hyperinsulinemia(95.65%vs.78.26%)in the study group were higher than those in the basic group(P<0.05).The satisfaction rates of operation(91.30%比69.57%),effectiveness(93.48%比67.36%)and comfort of the treatment plan(97.83%比69.57%)in the study group were higher than those in the basic group(P<0.05).There was no side effect in the basic group,1 case of hypoglycemia and no postoperative complications in the study group.There was no significant difference between the two groups(P>0.05).Conclusion In addition to diet,exercise therapy and basic drug therapy,special drugs and surgical treatment can control BMI,FPG,FINS and IR in obese patients with hyperinsulinemia.The curative effect of obesity and hyperinsulinemia is remarkable,and it can also reach the satisfaction of patients,saf

关 键 词：肥胖 高胰岛素血症 芬特明 奥利司他 二甲双胍 胃旁路术 治疗结果 

分 类 号：R587.2[医药卫生—内分泌] R589.2[医药卫生—内科学]