CAJ | 학술논문

目的观察格列美脲联合胰岛素治疗肾功能不全2型糖尿病的有效性及安全性.方法将78例胰岛素治疗血糖控制不佳且合并肾功能不全的2型糖尿病患者以分层随机化分组法分为胰岛素治疗组(40例)和格列美脲治疗组(38例),胰岛素治疗组根据血糖水平增加胰岛素剂量至血糖控制理想,格列美脲治疗组在原方案的基础上口服格列美脲,根据血糖情况调整胰岛素和格列美脲的剂量.比较治疗12周后2组空腹血糖、餐后2h血糖和糖化血红蛋白的变化与胰岛素日剂量、低血糖事件、血尿素氮、血肌酐、体质量、血脂、胰岛素抵抗指数(HOMA-IR)和高敏C反应蛋白(hs-CRP)、肿瘤坏死因子α(TNF-α)的变化.结果治疗12周,胰岛素治疗组患者体质量和胰岛素日剂量明显高于治疗前[分别为(78±12)kg比(74±12)kg,(88±11)U/L比(66±11)U/L],空腹血糖、餐后2h血糖、糖化血红蛋白和三酰甘油明显低于治疗前[分别为(8.2±2.2) mmol/L比(10.5±1.9) mmol/L,(14.2±2.3) mmol/L比(16.8±2.3)mmol/L,(7.6±0.8)％比(8.9±1.2)％,(2.6 ±1.1)mmol/L比(3.7±1.2)mmol/L],差异均有统计学意义(P＜0.05或P＜0.01);治疗12周格列美脲治疗组体质量、丙氨酸转氨酶、空腹血糖、餐后2h血糖、糖化血红蛋白、三酰甘油、hs-CRP、胰岛素抵抗指数、TNF-α和胰岛素日剂量明显低于治疗前[分别为(72±11) kg比(74±11)kg,(43 ±4)U/L比(57 ±6) U/L,(7.4±1.5) mmol/L比(10.8±2.0)mmol/L,(10.9±1.9) mmol/L比(16.5±2.4)mmoL/L,(6.8±0.6)％比(8.5±0.9)％,(2.3±1.0) mmol/L比(3.7 ± 1.2) mmol/L,(2.2±1.0) mg/L比(4.5±1.0)mg/L,(2.1±0.6)比(3.3±0.8),(16±4)μg/L比(24 ±6) μg/L,(40±12) U/d比(68±11) U/d],差异均有统计学意义(P＜0.05或P＜0.01).胰岛素治疗组有3例(7.5％)严重的低血糖事件,格列美脲治疗组无严重的低血糖事件,2组低血糖事件发生率差异无统计学意义(P＞0.05).结论合并肾功能不全的2型糖尿病患者胰岛素治疗血糖控制不佳者加用格列美脲后血糖控制良好,胰岛素日剂量明显降低,不增加体质量和低血糖,对肾功能无影响,同时降低TNF-α、hs-CRP、三酰甘油,改善胰岛素抵抗、减轻炎症.胰岛素联合格列美脲治疗伴有肾功能不全的2型糖尿病患者安全有效,不失为一种较好的临床治疗方案. 目的觀察格列美脲聯閤胰島素治療腎功能不全2型糖尿病的有效性及安全性.方法將78例胰島素治療血糖控製不佳且閤併腎功能不全的2型糖尿病患者以分層隨機化分組法分為胰島素治療組(40例)和格列美脲治療組(38例),胰島素治療組根據血糖水平增加胰島素劑量至血糖控製理想,格列美脲治療組在原方案的基礎上口服格列美脲,根據血糖情況調整胰島素和格列美脲的劑量.比較治療12週後2組空腹血糖、餐後2h血糖和糖化血紅蛋白的變化與胰島素日劑量、低血糖事件、血尿素氮、血肌酐、體質量、血脂、胰島素牴抗指數(HOMA-IR)和高敏C反應蛋白(hs-CRP)、腫瘤壞死因子α(TNF-α)的變化.結果治療12週,胰島素治療組患者體質量和胰島素日劑量明顯高于治療前[分彆為(78±12)kg比(74±12)kg,(88±11)U/L比(66±11)U/L],空腹血糖、餐後2h血糖、糖化血紅蛋白和三酰甘油明顯低于治療前[分彆為(8.2±2.2) mmol/L比(10.5±1.9) mmol/L,(14.2±2.3) mmol/L比(16.8±2.3)mmol/L,(7.6±0.8)％比(8.9±1.2)％,(2.6 ±1.1)mmol/L比(3.7±1.2)mmol/L],差異均有統計學意義(P＜0.05或P＜0.01);治療12週格列美脲治療組體質量、丙氨痠轉氨酶、空腹血糖、餐後2h血糖、糖化血紅蛋白、三酰甘油、hs-CRP、胰島素牴抗指數、TNF-α和胰島素日劑量明顯低于治療前[分彆為(72±11) kg比(74±11)kg,(43 ±4)U/L比(57 ±6) U/L,(7.4±1.5) mmol/L比(10.8±2.0)mmol/L,(10.9±1.9) mmol/L比(16.5±2.4)mmoL/L,(6.8±0.6)％比(8.5±0.9)％,(2.3±1.0) mmol/L比(3.7 ± 1.2) mmol/L,(2.2±1.0) mg/L比(4.5±1.0)mg/L,(2.1±0.6)比(3.3±0.8),(16±4)μg/L比(24 ±6) μg/L,(40±12) U/d比(68±11) U/d],差異均有統計學意義(P＜0.05或P＜0.01).胰島素治療組有3例(7.5％)嚴重的低血糖事件,格列美脲治療組無嚴重的低血糖事件,2組低血糖事件髮生率差異無統計學意義(P＞0.05).結論閤併腎功能不全的2型糖尿病患者胰島素治療血糖控製不佳者加用格列美脲後血糖控製良好,胰島素日劑量明顯降低,不增加體質量和低血糖,對腎功能無影響,同時降低TNF-α、hs-CRP、三酰甘油,改善胰島素牴抗、減輕炎癥.胰島素聯閤格列美脲治療伴有腎功能不全的2型糖尿病患者安全有效,不失為一種較好的臨床治療方案.
목적 관찰격렬미뇨연합이도소치료신공능불전2형당뇨병적유효성급안전성.방법 장78례이도소치료혈당공제불가차합병신공능불전적2형당뇨병환자이분층수궤화분조법분위이도소치료조(40례)화격렬미뇨치료조(38례),이도소치료조근거혈당수평증가이도소제량지혈당공제이상,격렬미뇨치료조재원방안적기출상구복격렬미뇨,근거혈당정황조정이도소화격렬미뇨적제량.비교치료12주후2조공복혈당、찬후2h혈당화당화혈홍단백적변화여이도소일제량、저혈당사건、혈뇨소담、혈기항、체질량、혈지、이도소저항지수(HOMA-IR)화고민C반응단백(hs-CRP)、종류배사인자α(TNF-α)적변화.결과 치료12주,이도소치료조환자체질량화이도소일제량명현고우치료전[분별위(78±12)kg비(74±12)kg,(88±11)U/L비(66±11)U/L],공복혈당、찬후2h혈당、당화혈홍단백화삼선감유명현저우치료전[분별위(8.2±2.2) mmol/L비(10.5±1.9) mmol/L,(14.2±2.3) mmol/L비(16.8±2.3)mmol/L,(7.6±0.8)％비(8.9±1.2)％,(2.6 ±1.1)mmol/L비(3.7±1.2)mmol/L],차이균유통계학의의(P＜0.05혹P＜0.01);치료12주격렬미뇨치료조체질량、병안산전안매、공복혈당、찬후2h혈당、당화혈홍단백、삼선감유、hs-CRP、이도소저항지수、TNF-α화이도소일제량명현저우치료전[분별위(72±11) kg비(74±11)kg,(43 ±4)U/L비(57 ±6) U/L,(7.4±1.5) mmol/L비(10.8±2.0)mmol/L,(10.9±1.9) mmol/L비(16.5±2.4)mmoL/L,(6.8±0.6)％비(8.5±0.9)％,(2.3±1.0) mmol/L비(3.7 ± 1.2) mmol/L,(2.2±1.0) mg/L비(4.5±1.0)mg/L,(2.1±0.6)비(3.3±0.8),(16±4)μg/L비(24 ±6) μg/L,(40±12) U/d비(68±11) U/d],차이균유통계학의의(P＜0.05혹P＜0.01).이도소치료조유3례(7.5％)엄중적저혈당사건,격렬미뇨치료조무엄중적저혈당사건,2조저혈당사건발생솔차이무통계학의의(P＞0.05).결론 합병신공능불전적2형당뇨병환자이도소치료혈당공제불가자가용격렬미뇨후혈당공제량호,이도소일제량명현강저,불증가체질량화저혈당,대신공능무영향,동시강저TNF-α、hs-CRP、삼선감유,개선이도소저항、감경염증.이도소연합격렬미뇨치료반유신공능불전적2형당뇨병환자안전유효,불실위일충교호적림상치료방안.
Objective To observe the effects of adding glimepiride on type 2 diabetic patients with renal insufficiency who was poorly controlled by insulin.Methods Seventy eight cases of type 2 diabetes patients with renal insufficiency,poorly controlled with large dose insulin,were randomly divided into glimepiride-added group (GM,n =38) and insulin group (INS,n =40).The INS group adjusted insulin dose until the plasma glucose was satisfying.The GM group added glimepiride.HbA1c,plasma glucose,daily insulin dose,number of hypoglycemic events,body weight,plasma lipid concentration,the levels of high sensitive C-reactive protein(hs-CRP),tumor necrosis factor-α(TNF-α) and HOMA-IR were measured before and 12 weeks after the therapy.Results At 12 weeks,body weight and daily insulin dose in INS group were significantly higher than those before treatment [(78 ± 12) kg vs (74 ± 12) kg,(88 ± 11) U vs (66 ± 11) U] ; fasting blood glucose,2 h postprandial blood glucose,HbAlc and triglycerides were decreased [(8.2 ± 2.2) mmol/L vs (10.5 ± 1.9) mmol/L,(14.2 ± 2.3) mmol/L vs (16.8 ±2.3)mmol/L,(7.6 ±0.8)％ vs (8.9 1.2)％,(2.6 ± 1.1)mmol/L vs (3.7 ± 1.2)mmol/L] (P ＜ 0.05 or P ＜ 0.01).In GM group,body weight,glutamic-pyruvic transaminase,fasting blood glucose,2 h postprandial blood glucose,HbAlc,triglycerides hs-CRP,HOMA-IR,TNF-α and daily insulin dose were lower than those before treatment [(72 ± 11) kg vs (74 ± 11) kg,(43 ± 4) U/L vs (57 ± 6) U/L,(7.4 ± 1.5) mmol/L vs (10.8 ±2.0)mmol/L,(10.9 ± 1.9) mmol/L vs (16.5 ±2.4) mmol/L,(6.8 ±0.6)％ vs (8.5 ±0.9)％,(2.3 ± 1.0)mmol/L vs (3.7 ± 1.2)mmol/L,(2.2 ± 1.0)mg/L vs (4.5 ± 1.0)mg/L,(2.1 ±0.6) vs (3.3 ±0.8),(16 ± 4) μμg/L vs (24 ± 6) μg/L,(40 ± 12) U/d vs (68 ± 11) U/d,respectively].There were 3 cases of severe hypoglycemic events in the INS groups.There was no statistically significant difference in mild hypoglycemic events and BUN,Cr in two groups (P ＞ 0.05).Conclusion Adding glimepiride to insulin therapy in the type 2 diabetes patients with renal insufficiency is safe and effective.