CAJ | 학술논문

目的观察短期持续性皮下胰岛素输注(CSII)治疗对伴明显高血糖的初诊2型糖尿病患者的降糖效果和胰岛β细胞功能的影响. 方法对空腹血糖>11.1 mmol/L的36例初诊2型糖尿病患者进行为期2周的CSII强化治疗,分析比较其治疗前后空腹及餐后2h血糖、糖化血红蛋白A1C、静脉葡萄糖耐量(IVGTT)试验时胰岛素分泌第一时相和胰岛素及C肽曲线下面积、空腹血浆胰岛素原、胰岛素原与胰岛素比值和由Homa模型计算的Homa β、Homa IR等.血浆胰岛素、C肽、胰岛素原浓度均用放免法测定. 结果 2周的CSII治疗显示出快速稳定的降血糖效果.其中35例患者的空腹、餐后2 h血糖分别于治疗后(2.7±1.9) d、(8.5±3.5) d达到良好控制,且未见明显低血糖.胰岛β细胞功能在治疗后获得显著改善:静脉注射葡萄糖后10 min内出现了明显增加的胰岛素、C肽分泌相,更有部分患者可以见到典型的胰岛素第一时相分泌尖峰,胰岛素、C肽曲线下面积和由Homa模型计算的Homa β值均较治疗前明显提高,而胰岛素原、胰岛素原与胰岛素比值则较治疗前明显下降.反映胰岛素抵抗的 Homa IR也较治疗前明显降低. 结论对伴明显高血糖的初诊2型糖尿病患者,短期CSII强化治疗具有快速稳定控制血糖和显著改善胰岛β细胞功能的作用.
목적관찰단기지속성피하이도소수주(CSII)치료대반명현고혈당적초진2형당뇨병환자적강당효과화이도β세포공능적영향. 방법대공복혈당>11.1 mmol/L적36례초진2형당뇨병환자진행위기2주적CSII강화치료,분석비교기치료전후공복급찬후2h혈당、당화혈홍단백A1C、정맥포도당내량(IVGTT)시험시이도소분비제일시상화이도소급C태곡선하면적、공복혈장이도소원、이도소원여이도소비치화유Homa모형계산적Homa β、Homa IR등.혈장이도소、C태、이도소원농도균용방면법측정. 결과 2주적CSII치료현시출쾌속은정적강혈당효과.기중35례환자적공복、찬후2 h혈당분별우치료후(2.7±1.9) d、(8.5±3.5) d체도량호공제,차미견명현저혈당.이도β세포공능재치료후획득현저개선:정맥주사포도당후10 min내출현료명현증가적이도소、C태분비상,경유부분환자가이견도전형적이도소제일시상분비첨봉,이도소、C태곡선하면적화유Homa모형계산적Homa β치균교치료전명현제고,이이도소원、이도소원여이도소비치칙교치료전명현하강.반영이도소저항적 Homa IR야교치료전명현강저. 결론대반명현고혈당적초진2형당뇨병환자,단기CSII강화치료구유쾌속은정공제혈당화현저개선이도β세포공능적작용.
Objective To evaluate the effect of short term continuous subcutaneous insulin infusion (CSII) treatment on plasma glucose and beta cell function in newly diagnosed type 2 diabetic patients with severe hyperglycemia. Methods Thirty six newly diagnosed type 2 diabetic patients with FPG>11.1 mmol/L were treated by 2 weeks CSII. An intravenous glucose tolerance test (IVGTT) was performed before and after CSII. Fasting plasma glucose (FPG), 2 hours postprandial glucose (2 hPG), glycosylated hemoglobin A 1c (GHbA 1C ), proinsulin, lipid profiles, insulin, and C peptide during IVGTT were measured. The results of FPG, 2hPG, GHbA1C, first phase insulin secretion, the mean area under the curve (AUC) of insulin and C peptide, proinsulin, proinsulin/insulin ratio, Homa β and Homa IR were compared. Results The excellent control of FPG and 2hPG in 35 out of 36 patients were achieved stably in 2.7±1.9 days and 8.5±3.5 days by CSII. After 2 weeks CSII intensive treatment, beta cell function was dramatically improved: the first phase insulin secretion of most patients was restored in different degrees, the sharp peaks of insulin release were seen in some patients. The mean AUC of insulin and C peptide and Homa β were significantly increased; plasma proinsulin, proinsulin/insulin ratio and Homa IR were decreased. Conclusion The excellent glycemic control and improvement of beta cell function can be induced by short term CSII intensive therapy in newly diagnosed type 2 diabetic patients with severe hyperglycemia.