采用胰岛素泵治疗对初诊糖尿病患者胰岛β细胞功能的影响  

Effect of continuous substaneous insulin infusion on islet beta cell function in newly diagnosed diabetic patients

作　　者：李硕良 冯秀娟 何华平 伍洁燕 谭瑞珠 Li Shuoliang;Feng Xiujuan;He Huaping;Wu Jieyan;Tan Ruizhu(Department of Endocrinology,Taishan People's Hospital,Taishan 529200,Guangdong Province,China)

机构地区：[1]台山市人民医院内分泌科,广东省529200

出　　处：《中国基层医药》2021年第4期487-490,共4页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的:观察采用胰岛素泵(CSⅡ)治疗对初诊糖尿病患者胰岛β细胞功能的影响。方法:选取2011年7月至2014年6月在台山市人民医院治疗的初诊糖尿病患者46例为研究对象,采用CSⅡ治疗14 d,并完成5年临床随访,比较治疗前后及5年后的空腹血糖(FPG)、餐后2 h血糖(2hPG)、甘油三酯(TG)、空腹胰岛素(FINS)、餐后2 h胰岛素(2hINS)、糖化血红蛋白(HbA1c)、超氧化物歧化酶(SOD)、丙二醛(MDA)水平和胰岛素抵抗指数(HOMA-IR)、胰岛素释放指数(HOMA-β)变化情况。结果:治疗后,FPG、2hPG、TG、HbA1c、MDA水平及HOMA-IR均较治疗前下降[FPG:(11.3±1.2)mmol/L比(5.9±0.4)mmol/L,t=15.35,P<0.01;2hPG:(18.1±4.2)mmol/L比(8.1±1.6)mmol/L,t=16.83,P<0.01;TG:(2.9±1.1)mmol/L比(1.5±0.6)mmol/L,t=9.81,P<0.01;HbA1c:(11.2±2.5)%比(5.6±1.0)%,t=11.48,P<0.01;MDA:(4.6±1.2)μmol/L比(2.7±0.9)μmol/L,t=16.37,P<0.01;HOMA-IR:(2.81±0.35)比(1.87±0.32),t=9.37,P<0.01],FINS、2hINS、SOD水平及HOMA-β高于治疗前[FINS:(5.6±1.3)mU/L比(7.4±1.5)mU/L,t=-6.15,P<0.01;2hINS:(15.8±7.5)mU/L比(25.8±9.1)mU/L,t=-5.65,P<0.01;SOD:(28.9±7.6)U/L比(39.6±7.8)U/L,t=-7.93,P<0.01;HOMA-β:(14.36±3.82)比(65.67±6.67),t=-18.72,P<0.01]。线性回归分析结果表明,HOMA-β与SOD水平均呈正相关(R2=0.319,P<0.01)。5年后所有患者治疗方案的最终转归为胰岛素治疗3例(6.5%),口服药物治疗25例(54.4%),仅生活方式干预18例(39.1%)。结论:采用CSⅡ治疗初诊糖尿病,有效抑制氧化应激,改善胰岛β细胞功能,具有远期效应。Objective To investigate the effects of continuous substaneous insulin infusion(CSII)on isletβcell function in newly diagnosed diabetic patients.Methods Forty-six newly diagnosed diabetic patients who received treatment in Taishan People's Hospital from July 2011 to June 2014 were included in this study.They were treated with CSII for 14 days and followed up for 5 years.Before and after treatment,fasting blood glucose(FPG),2-h postprandial blood glucose(2hPG),triglyceride(TG),fasting insulin(FINS),2-h postprandial insulin(2hINS),glycosylated hemoglobin(HbA1c),superoxide dismutase(SOD),malondialdehyde(MDA)and the Homeostatic Model Assessment for Insulin Resistance(HOMA-IR)index,Homeostasis Model Assessment for beta-cell function(HOMA-β)index were compared between before treatment and 5 years after treatment.Results Five years after treatment,the levels of FPG,2hPG,TG,HbA1c,MDA and HOMA-IR were lower than those before treatment[FPG:(11.3±1.2)mmol/L vs.(5.9±0.4)mmol/L,t=15.35,P<0.01;2hPG:(18.1±4.2)mmol/L vs.(8.1±1.6)mmol/L,t=16.83,P<0.01;TG:(2.9±1.1)mmol/L vs.(1.5±0.6)mmol/L,t=9.81,P<0.01;HbA1c:(11.2±2.5)%vs.(5.6±1.0)%,t=11.48,P<0.01;MDA:(4.6±1.2)μmol/L vs.(2.7±0.9)μmmol/L,t=16.37,P<0.01;HOMA-IR:(2.81±0.35)vs.(1.87±0.32),t=9.37,P<0.01].Five years after treatment,the levels of FINS,2hINS,SOD and HOMA-βwere significantly higher than those before treatment[FINS:(5.6±1.3)mU/L vs.(7.4±1.5)mU/L,t=-6.15,P<0.01;2hINS:(15.8±7.5)mU/L vs.(25.8±9.1)mU/L,t=-5.65,P<0.01;SOD:(28.9±7.6)U/L vs.(39.6±7.8)U/L,t=-7.93,P<0.01;HOMA-β:(14.36±3.82)vs.(65.67±6.67),t=-18.72,P<0.01].Linear regression analysis showed that HOMA-βwas positively correlated with SOD level(R2=0.319,P<0.01).Five years after treatment,the final outcome was insulin therapy in 3 cases(6.5%),oral medication in 25 cases(54.4%),and lifestyle intervention in 18 cases(39.1%).Conclusion CS II for the treatment of newly diagnosed diabetes mellitus can effectively inhibit oxidative stress,improve the function of isletβcells,and exhibit long-term eff

关 键 词：糖尿病 胰岛素输注系统 血糖 胰岛素 氧化应激 胰岛Β细胞功能 

分 类 号：R587.1[医药卫生—内分泌]