西格列汀对应用大剂量胰岛素效果欠佳的2型糖尿病的疗效分析  

Analysis of the efficacy of high dose insulin combined with DDP4 inhibitor in patients with type 2 diabetes mellitus

作　　者：梁焯辉 刘倩雯 梁红玉 赵凡 区苑清 黎惠贞 LIANG Zhuo-hui;LIU Qian-wen;LIANG Hong-yu;ZHAO Fan;QU Yuan-qing;LI Hui-zhen(Department of Endocrinology,the People's Hospital of Jiangmen,Jiangmen 529000,Guangdong,China)

机构地区：[1]江门市人民医院内分泌科,广东江门529000

出　　处：《川北医学院学报》2021年第5期606-610,共5页Journal of North Sichuan Medical College

基　　金：广东省江门市科技计划项目(2018B017)。

摘　　要：目的:探讨联合临床一线降糖药与DDP4抑制剂治疗对应用大剂量胰岛素但血糖控制仍欠佳的2型糖尿病(T2DM)的临床疗效及安全性。方法:将180例应用大剂量胰岛素效果欠佳的T2DM患者按照联合用药不同方案分为A组(西格列汀治疗24周)、B组(二甲双胍治疗24周)和C组(吡格列酮治疗24周),每组各60例。所有患者均给予胰岛素基础治疗,每日剂量>50 U。评价各组治疗后的临床疗效,检测各组治疗前后空腹胰岛素(FINS)、餐后2 h胰岛素(2 h INS)、空腹C肽(FCP)、餐后2 h C肽(2 h CP)、胰岛B细胞功能水平(HOMA-B)及胰岛素抵抗指数(HOMA-IR)。比较各组治疗前后空腹血糖(FPG)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白-胆固醇(LDL-C)和高密度脂蛋白-胆固醇(HDL-C)。检测各组治疗前后尿素氮(BUN)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、血肌酐(Scr)及炎性因子血清白细胞介素6(IL-6)、C反应蛋白(CRP)及肿瘤坏死因子α(TNF-α)水平。记录治疗过程中出现的不良反应事件。结果:与治疗前比较,治疗后A组总有效率为95.0%,B组为91.7%、C组为88.3%,差异无统计学意义(P>0.05);治疗后各组FINS、2 h INS、FCP、2 h CP、HOMA-B水平明显升高,HOMA-IR显著降低(P<0.05),A组HOMA-B水平高于B和C组(P<0.05);治疗后各组HbAlc、FPG、TG、LDL-C水平均明显下降(P<0.05),组间比较差异无统计学意义(P>0.05);治疗后各组CRP、IL-6和TNF-α水平显著降低(P<0.05),组间比较差异无统计学意义(P>0.05);治疗前后,各组ALT、AST、BUN和Scr水平比较,差异无统计学意义(P>0.05);A组低血糖等不良反应发生率为6.7%,低于B组的23.3%和C组的25.0%(P<0.05)。结论:西格列汀相比传统口服降糖药,在显著改善患者血糖状况的同时,不增加低血糖等不良反应的发生率,并对胰岛B细胞有潜在的保护作用,可作为与胰岛素联合用药治疗的理想选择。Objective:To investigate the clinical efficacy and safety of high dose insulin combined with DDP4 inhibitors in patients with type 2 diabetes mellitus(T2DM).Methods:A total of 180 patients with T2DM with poor efficacy of high-dose insulin were randomly divided into group A(n=60,24 weeks of treatment with sitagliptin),group B(n=60,24 weeks of treatment with metformin)and group C(n=60,24 weeks of treatment with pioglitazone).All patients were given basic insulin therapy,daily dose>50 U.After treatment,the clinical efficacy of each group was evaluated.Fasting insulin(FINS),insulin(2 hINS),fasting C-peptide(FCP),2h C-peptide(2 hCP),islet B cell functional level(HOMA-B)and insulin resistance index(HOMA-IR)were measured before and after treatment.Fasting blood glucose(FPG),total cholesterol(TC),triacylglycerol(TG),low-density lipoprotein cholesterol(LDL-C)and high-density lipoprotein cholesterol(HDL-C)were compared before and after treatment in each group.Blood urea nitrogen(BUN),alanine aminotransferase(ALT),aspartate aminotransferase(AST),serum creatinine(Scr)and inflammatory factors serum interleukin-6(IL-6),C-reactive protein(CRP)and tumor necrosis factor(TNF-α)levels were measured before and after treatment in each group.Adverse events occurred during treatment were recorded.Results:Compared with before treatment,the total effective rate was 95.0%in group A,91.7%in group B and 88.3%in group C after treatment,the difference was not statistically significant(P>0.05).After treatment,the levels of FINS,2hINS,FCP,2hCP and HOMA-B in each group were significantly increased,while those of HOMA-IR were significantly decreased(P<0.05).The levels of HOMA-B in group A were significantly higher than those in group B and group C(P<0.05).After treatment,the HbAlc,FPG,TG and LDL-C levels in each group were significantly decreased(P<0.05),there was no significant difference between groups(P>0.05).After treatment,the levels of CRP,IL-6 and TNF-αin each group were significantly reduced(P<0.05),there was no significant difference b

关 键 词：2型糖尿病 胰岛素抵抗 西格列汀 疗效 安全性 

分 类 号：R977.1[医药卫生—药品] R587.1[医药卫生—药学]