CAJ | 학술논문

目的：观察胰岛素泵强化治疗对2型糖尿病( T2DM)合并冠心病患者血糖波动及血清内皮脂肪酶( EL)、超敏C反应蛋白( hs-CRP)的影响。方法选择2013年6月-2014年3月在北京军区总医院内分泌科住院的T2DM合并冠心病患者60例。入院当天行72 h动态血糖监测(CGM),并予胰岛素泵皮下持续输注强化治疗10~14 d,血糖控制平稳后再次行CGM,比较治疗前后日内平均血糖波动幅度( MAGE)、全天血糖标准差( SDBG)、最大血糖波动幅度( LAGE)；治疗前后测量患者身高、体重计算体重指数( BMI),空腹采集患者静脉血检测空腹血糖( FPG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(HbA1c)、hs-CRP及EL,计算胰岛素抵抗指数(HOMA-IR)；分析治疗前EL水平与其他指标的相关性。结果与治疗前比较,本组治疗后HOMA-IR、EL、hs-CRP、MAGE、SDBG、LAGE均显著降低(P<0.05,P<0.01)；Pearson相关分析显示,治疗前EL水平与hs-CRP、MAGE水平呈显著正相关(r=0.517、0.428, P<0.01)。结论对T2DM合并冠心病患者予胰岛素泵强化治疗不仅可降糖、控制血糖波动,还能抗炎、抗动脉粥样硬化,对糖尿病大血管并发症的防治起到重要作用。
목적：관찰이도소빙강화치료대2형당뇨병( T2DM)합병관심병환자혈당파동급혈청내피지방매( EL)、초민C반응단백( hs-CRP)적영향。방법선택2013년6월-2014년3월재북경군구총의원내분비과주원적T2DM합병관심병환자60례。입원당천행72 h동태혈당감측(CGM),병여이도소빙피하지속수주강화치료10~14 d,혈당공제평은후재차행CGM,비교치료전후일내평균혈당파동폭도( MAGE)、전천혈당표준차( SDBG)、최대혈당파동폭도( LAGE)；치료전후측량환자신고、체중계산체중지수( BMI),공복채집환자정맥혈검측공복혈당( FPG)、찬후2 h혈당(2 h PG)、당화혈홍단백(HbA1c)、hs-CRP급EL,계산이도소저항지수(HOMA-IR)；분석치료전EL수평여기타지표적상관성。결과여치료전비교,본조치료후HOMA-IR、EL、hs-CRP、MAGE、SDBG、LAGE균현저강저(P<0.05,P<0.01)；Pearson상관분석현시,치료전EL수평여hs-CRP、MAGE수평정현저정상관(r=0.517、0.428, P<0.01)。결론대T2DM합병관심병환자여이도소빙강화치료불부가강당、공제혈당파동,환능항염、항동맥죽양경화,대당뇨병대혈관병발증적방치기도중요작용。
Objective To observe the influence of intensive insulin pump treatment on levels of mean amplitude of glycemic excursions ( MAGE) , serum endothelial lipase ( EL) and high sensitive C-reactive protein ( hs-CRP) in type 2 diabetic (T2DM) patients with coronary heart disease. Methods Sixty patients with T2DM complicated with coronary heart disease during June 2013 and March 2014 were selected. All the patients were given the continuous glucose monito-ring ( CGM) for 72 h, and then the intensive insulin pump treatment was given for 10 - 14 d. The CGM for 72 h was performed again after the level of blood sugar remained stable, and the levels of mean amplitude of glycemic excursions (MAGE), standard deviation of blood glucose (SDBG) and largest amplitude of glycemic excursions (LAGE) before and after the treatment were compared. The indexes levels of height, weight, body mass index (BMI), fasting plasma glucose (FPG), two-hour plasma glucose (2 h PG), glycated hemoglobin (HbA1c), high sensitive C reactive protein ( hs-CRP) , endothelial lipase ( EL) and insulin resistance index ( HOMA-IR) before and after treatment were detected;the correlation between EL level and other indexes before the treatment was also analyzed. Results Compared with those before treatment, the levels of HOMA-IR, EL, hs-CRP, MAGE, SDBG and LAGE were significantly reduced ( P <0. 05, P<0. 01);Pearson correlation analysis showed that before the treatment the serum EL level was positively correla-ted with hs-CRP and MAGE levels (r=0. 517, 0. 428, P<0. 01). Conclusion Intensive insulin pump treatment for T2DM patients with coronary heart disease may not only reduce blood sugar level and control blood sugar fluctuation, but also play an important role of anti-inflammation and anti-atherosclerosis, which is important to prevent diabetic large ves-sels complication.