CAJ | 학술논문

目的：探究短期胰岛素强化治疗对初诊2型糖尿病患者胰岛B细胞功能及胰岛素敏感性的影响，并将两种强化胰岛素的治疗方法进行对比观察，比较治疗效果。方法选取近两年收治的80例初诊2型糖尿病患者，空腹血糖均在11.1mmol/L以上，将80例患者分为皮下多次注射胰岛素组和胰岛素泵组，每组40例，另选择同一时期来院进行体检的健康人群40例作为对照组,对糖尿病患者进行2周的胰岛素强化治疗,比较强化治疗前后血糖、血三酰甘油(TG)及总胆固醇(TC)、空腹胰岛素原(FPI)、空腹胰岛素(FIns)、FPI/FIns、HomaB功能指数(HBCI)及口服馒头餐—胰岛素释放试验中糖负荷后胰岛素曲线下面积(AUCi)、AUCi/AUCg、糖负荷后30min胰岛素增值与血糖增值的比值(ΔI30’/ΔG30’),以上指标在两组患者中进行对比分析。结果(1)与健康对照组比较，两组患者的血糖、三酰甘油、总胆固醇和糖化血红蛋白(GHbA1c)水平明显偏高,比较差异具有显著性(P<0.05)；但注射胰岛素组和胰岛素泵组间比较差异不具有显著性(P>0.05)；(2)经过强化胰岛素治疗之后,FIns、FIns/FBG、HBCI、AUCi和AUCi/AUCg,以及ΔI30’/ΔG30’与治疗前相比较有明显升高，且差异具有显著性(P<0.01或P<0.05),血糖、TG、TC和FPI和FPI/Fins与治疗前比较显著下降，其差异具有显著性(P<0.01或P<0.05)；每日所用的胰岛素总量比较，胰岛素泵组明显少于胰岛素注射组,且胰岛素泵组患者明显缩短了患者的血糖达标时间，能够很好地反映胰岛B功能，同时各指标有显著的改善，两组比较差异均具有显著性(P<0.05)。结论对于初诊2型糖尿病患者给予短期的胰岛素强化治疗，能够明显改善患者胰岛B细胞功能及增强胰岛素的敏感性，同时采用胰岛素泵治疗效果更佳，值得在临床推广使用。
목적：탐구단기이도소강화치료대초진2형당뇨병환자이도B세포공능급이도소민감성적영향，병장량충강화이도소적치료방법진행대비관찰，비교치료효과。방법선취근량년수치적80례초진2형당뇨병환자，공복혈당균재11.1mmol/L이상，장80례환자분위피하다차주사이도소조화이도소빙조，매조40례，령선택동일시기래원진행체검적건강인군40례작위대조조,대당뇨병환자진행2주적이도소강화치료,비교강화치료전후혈당、혈삼선감유(TG)급총담고순(TC)、공복이도소원(FPI)、공복이도소(FIns)、FPI/FIns、HomaB공능지수(HBCI)급구복만두찬—이도소석방시험중당부하후이도소곡선하면적(AUCi)、AUCi/AUCg、당부하후30min이도소증치여혈당증치적비치(ΔI30’/ΔG30’),이상지표재량조환자중진행대비분석。결과(1)여건강대조조비교，량조환자적혈당、삼선감유、총담고순화당화혈홍단백(GHbA1c)수평명현편고,비교차이구유현저성(P<0.05)；단주사이도소조화이도소빙조간비교차이불구유현저성(P>0.05)；(2)경과강화이도소치료지후,FIns、FIns/FBG、HBCI、AUCi화AUCi/AUCg,이급ΔI30’/ΔG30’여치료전상비교유명현승고，차차이구유현저성(P<0.01혹P<0.05),혈당、TG、TC화FPI화FPI/Fins여치료전비교현저하강，기차이구유현저성(P<0.01혹P<0.05)；매일소용적이도소총량비교，이도소빙조명현소우이도소주사조,차이도소빙조환자명현축단료환자적혈당체표시간，능구흔호지반영이도B공능，동시각지표유현저적개선，량조비교차이균구유현저성(P<0.05)。결론대우초진2형당뇨병환자급여단기적이도소강화치료，능구명현개선환자이도B세포공능급증강이도소적민감성，동시채용이도소빙치료효과경가，치득재림상추엄사용。
Objective: To explore the short-term insulin intensive treatment of newly diagnosed type 2 diabetic islets B cell function and insulin sensitivity and the two intensive insulin treatment were observed and compared, and compare the therapeutic effect. Methods:80 cases of newly diagnosed in recent years treated patients with type 2 diabetes, fasting blood glucose levels were above 11.1mmol/L, 80 patients were divided into multiple subcutaneous insulin injection group and insulin pump group, 40 cases in each group, the other healthy people choose the same period to hospital for medical examination of 40 cases as control group, intensive treatment 2 week of insulin for diabetic patients, compared before and after treatment, blood glucose, strengthening three triglycerides (TG) and total cholesterol (TC), fasting insulin (FPI), fasting insulin (FIns), FPI/FIns HomaB functional index (HBCI), steamed bread meal and oral insulin release test in postprandial insulin area under the curve (AUCi), the ratio of AUCi/AUCg, 30min blood glucose and insulin after glucose load increment value (I30’/ G30’), the above indexes were compared in the two groups.Results:(1) compared with the control group, two groups of patients with blood glucose, triglyceride, total cholesterol and three glycosylated hemoglobin (GHbA1c) level was significantly higher, the difference was statistically significant (P < 0.05); but the insulin group and insulin pump group compared the difference was not significant (P > 0.05); (2) after intensive insulin therapy, FIns, FIns/FBG, HBCI, AUCi and AUCi/AUCg, and G30’and delta I30’/ delta compared to before treatment increased significantly, and the difference was signi昀cant (P<0.01 orP<0.05), blood glucose, TG, TC and FPI and FPI/Fins decreased significantly compared with before treatment, the difference was significant of (P<0.01 orP<0.05); compared with the total daily insulin, insulin pump group was significantly less than the insulin injection group, and insulin pump group were significantly shortened the time of blood glucose in patients with, can well refiect the islet function of B, while the index has been significantly improved, the difference between the two groups was significant (P<0.05). Conclusion:For patients with newly diagnosed type 2 diabetes given short-term insulin intensive treatment, can significantly improve enhanced insulin sensitivity and islet B cell function in patients with, at the same time, the use of insulin pump therapy effect is better, and is worth popularizing in clinical use.