C肽BMI在2型糖尿病患者选择降糖药方案中的预测作用  

The predictive effect of C-peptide and body mass index in type 2 diabetic patients choosing basal insulin-supported oral drug(s)therapy

作　　者：张树杰[1] 郑宪玲[1] 张瑞清[1] 张凯 ZHANG Shujie;ZHENG Xianling;ZHANG Ruiqing;ZHANG Kai(Department of Endocrinology,Handan Central Hospital,Handan 056000,China;Department of Pharmacy,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]邯郸市中心医院内分泌科,河北邯郸056000 [2]河北省医科大学第二医院药剂科,河北石家庄050000

出　　处：《安徽医学》2022年第12期1392-1396,共5页Anhui Medical Journal

基　　金：河北省医学科学研究课题计划(项目编号:20191847)。

摘　　要：目的探讨C肽、身体质量指数(BMI)对血糖控制不佳的2型糖尿病(T2DM)患者选择基础胰岛素加口服降糖药方案的预测作用。方法选取2019年1月至2021年9月邯郸市中心医院内分泌科收治的211例血糖控制不佳的T2DM患者,给予多次皮下注射胰岛素(MDI)治疗,达到并维持血糖控制目标后改为基础胰岛素加口服药(BOT)治疗,如转换成功,则归入观察组(BOT组,n=142),如不成功,则归入对照组(MDI组,n=69),继续胰岛素强化治疗。比较2组患者糖尿病病程、空腹血糖、餐后2 h血糖、糖化血红蛋白、空腹C肽、餐后2 h C肽(2 h C-P)、BMI等指标差异。结果与MDI组相比,BOT组糖尿病病程较短[(7.41±6.78)年比(10.32±7.64)年,P<0.05],且BMI、2 h C-P高于MDI组[(26.53±3.65)kg/m~2比(22.58±4.09)kg/m~2、3.67(2.63,5.19)ng/mL比1.40(1.0,2.06)ng/mL,P<0.05]。多因素logistic回归分析结果显示,病程、BMI、2 h C-P为选择BOT方案的影响因素(β=-0.065、0.198、0.914,P<0.05)。受试者工作特征曲线显示BMI和2 h C-P曲线下面积分别为0.780、0.860(P<0.05),预测BOT方案的最佳截断值分别为24.21 kg/m~2(灵敏度为0.76、特异度为0.73)、2.43μg/L(灵敏度为0.77、特异度为0.83)。结论BMI、2 h C-P可作为血糖控制不佳的T2DM患者选择基础胰岛素加口服降糖药方案的预测指标,指导用药方案的选择。Objective To investigate the predictive effects of C-peptide and body mass index on type 2 diabetic patients received basal insulin combined with oral drug(s)therapy.Methods A total of 211 type 2 diabetic patients with poor blood glucose control who were hospitalized in the Department of Endocrinology,Handan Central Hospital from January 2019 to September 2021 were selected,then they were treated with multiple daily injections of insulin(MDI).After achieving and maintaining the blood glucose control goals,they were changed to basic insulin plus oral drugs treatment.If the conversion was successful,they were assigned to the BOT group,if not,they were assigned to the MDI group,and intensive insulin treatment was continued.The baseline data of the two groups were compared,including duration of diabetes,FPG,HbA1 c,FC-P,2 h C-P,body mass index(BMI).Results Compared with MDI group,BOT group had shorter duration of diabetes[(7.41±6.78)vs(10.32±7.64)years,P<0.01],higher BMI[(26.53±3.65)vs(22.58±4.09)kg/m~2]and higher 2 h C-P[3.67(2.63,5.19)vs 1.40(1.0,2.06)ng/mL,P<0.01].The result of multi-independent logistic regression analysis showed that the duration of diabetes,BMI and 2 h C-P were influencing factors for BOT selection(β=-0.065,0.20,0.91,P<0.01).ROC curve showed that the areas under BMI and 2 h C-P curves were 0.78 and 0.86(P<0.01),respectively,and their cut-off point values to choose BOT were 24.21 kg/m~2(sensitivity was 0.76,and specificity was 0.73)and 2.43μg/L(sensitivity was 0.77,and specificity was 0.83).Conclusions For type 2 diabetic patients with poor blood glucose control,2 h C-P and BMI can be used as predictive indicators to guide the choice of basal insulin combined with oral drug(s)therapy.

关 键 词：基础胰岛素加口服药 身体质量指数 C肽 2型糖尿病 

分 类 号：R587.1[医药卫生—内分泌]