温州医科大学学报
溫州醫科大學學報
온주의과대학학보
Journal of Wenzhou Medical University
2015年
10期
748-752
,共5页
张爱鸣%沈丽珍%厉钗微%高赛赛
張愛鳴%瀋麗珍%厲釵微%高賽賽
장애명%침려진%려차미%고새새
循环内皮祖细胞%初发2型糖尿病%胰岛素强化治疗%口服降糖药
循環內皮祖細胞%初髮2型糖尿病%胰島素彊化治療%口服降糖藥
순배내피조세포%초발2형당뇨병%이도소강화치료%구복강당약
circulating endothelial progenitor cells%newly diagnosed type 2 diabetic%early intensive insulin therapy%oral hypoglycemic drugs
目的：探讨不同降糖方案对初发2型糖尿病患者循环内皮祖细胞（EPCs）数量的影响。方法：通过纳入标准和排除标准，选取初发2型糖尿病住院患者，共45例，记录其年龄、性别、身高、体质量、腹围并计算体质量指数（BMI），同时检测空腹血糖（FPG）、空腹胰岛素（FINS）、餐后2h血糖（PPG）、糖化血红蛋白（HbA1c）、胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）等主要指标。根据降糖方案不同，将初发2型糖尿病患者随机分为3组。A组（15例）：胰岛素皮下泵（CSII，诺和锐针）治疗2周后改为一日2次预混胰岛素治疗（优泌乐25针，一日2次）；B组（15例）：口服降糖药物治疗组（达美康缓释片30～120mg/d）；C组（15例）：一日2次预混胰岛素治疗组（优泌乐25针，一日2次）。测定一般临床资料后，用流式细胞仪测定治疗前、治疗4周后的CD34和KDR双标阳性EPCs水平，进行治疗前后的组内比较与治疗后3组之间的组间比较。结果：治疗前，A、B、C3组各项临床指标及EPCs的数量水平相近（P＞0.05）。组内比较显示各组经治疗后，EPCs数量均明显升高，差异有统计学意义（P＜0.05）。治疗4周后，A、C2组的EPCs数量水平明显高于口服降糖药B组（P＜0.05），而A组与C组的EPCs数量水平相当（P＞0.05）。同时多元线性回归分析显示：EPCs的数量与HbA1c呈负相关（R2=0.664，P＜0.05）。结论：对于初发2型糖尿病患者，首选胰岛素强化治疗方案，快速缓解“高糖毒性”的同时，能够提高患者EPCs数量，从而可能进一步改善糖尿病引起的内皮功能障碍，对预防及延缓糖尿病慢性血管并发症的发生与发展起着一定的作用。血糖水平直接影响了糖尿病患者的EPCs的数量，即HbA1c越高，其EPCs的数量越少。
目的：探討不同降糖方案對初髮2型糖尿病患者循環內皮祖細胞（EPCs）數量的影響。方法：通過納入標準和排除標準，選取初髮2型糖尿病住院患者，共45例，記錄其年齡、性彆、身高、體質量、腹圍併計算體質量指數（BMI），同時檢測空腹血糖（FPG）、空腹胰島素（FINS）、餐後2h血糖（PPG）、糖化血紅蛋白（HbA1c）、膽固醇（TC）、甘油三酯（TG）、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）等主要指標。根據降糖方案不同，將初髮2型糖尿病患者隨機分為3組。A組（15例）：胰島素皮下泵（CSII，諾和銳針）治療2週後改為一日2次預混胰島素治療（優泌樂25針，一日2次）；B組（15例）：口服降糖藥物治療組（達美康緩釋片30～120mg/d）；C組（15例）：一日2次預混胰島素治療組（優泌樂25針，一日2次）。測定一般臨床資料後，用流式細胞儀測定治療前、治療4週後的CD34和KDR雙標暘性EPCs水平，進行治療前後的組內比較與治療後3組之間的組間比較。結果：治療前，A、B、C3組各項臨床指標及EPCs的數量水平相近（P＞0.05）。組內比較顯示各組經治療後，EPCs數量均明顯升高，差異有統計學意義（P＜0.05）。治療4週後，A、C2組的EPCs數量水平明顯高于口服降糖藥B組（P＜0.05），而A組與C組的EPCs數量水平相噹（P＞0.05）。同時多元線性迴歸分析顯示：EPCs的數量與HbA1c呈負相關（R2=0.664，P＜0.05）。結論：對于初髮2型糖尿病患者，首選胰島素彊化治療方案，快速緩解“高糖毒性”的同時，能夠提高患者EPCs數量，從而可能進一步改善糖尿病引起的內皮功能障礙，對預防及延緩糖尿病慢性血管併髮癥的髮生與髮展起著一定的作用。血糖水平直接影響瞭糖尿病患者的EPCs的數量，即HbA1c越高，其EPCs的數量越少。
목적：탐토불동강당방안대초발2형당뇨병환자순배내피조세포（EPCs）수량적영향。방법：통과납입표준화배제표준，선취초발2형당뇨병주원환자，공45례，기록기년령、성별、신고、체질량、복위병계산체질량지수（BMI），동시검측공복혈당（FPG）、공복이도소（FINS）、찬후2h혈당（PPG）、당화혈홍단백（HbA1c）、담고순（TC）、감유삼지（TG）、고밀도지단백（HDL）、저밀도지단백（LDL）등주요지표。근거강당방안불동，장초발2형당뇨병환자수궤분위3조。A조（15례）：이도소피하빙（CSII，낙화예침）치료2주후개위일일2차예혼이도소치료（우비악25침，일일2차）；B조（15례）：구복강당약물치료조（체미강완석편30～120mg/d）；C조（15례）：일일2차예혼이도소치료조（우비악25침，일일2차）。측정일반림상자료후，용류식세포의측정치료전、치료4주후적CD34화KDR쌍표양성EPCs수평，진행치료전후적조내비교여치료후3조지간적조간비교。결과：치료전，A、B、C3조각항림상지표급EPCs적수량수평상근（P＞0.05）。조내비교현시각조경치료후，EPCs수량균명현승고，차이유통계학의의（P＜0.05）。치료4주후，A、C2조적EPCs수량수평명현고우구복강당약B조（P＜0.05），이A조여C조적EPCs수량수평상당（P＞0.05）。동시다원선성회귀분석현시：EPCs적수량여HbA1c정부상관（R2=0.664，P＜0.05）。결론：대우초발2형당뇨병환자，수선이도소강화치료방안，쾌속완해“고당독성”적동시，능구제고환자EPCs수량，종이가능진일보개선당뇨병인기적내피공능장애，대예방급연완당뇨병만성혈관병발증적발생여발전기착일정적작용。혈당수평직접영향료당뇨병환자적EPCs적수량，즉HbA1c월고，기EPCs적수량월소。
Objective:To investigate the effects of different hypoglycemic programme on the inlfuence of the number of circulating endothelial progenitor cells (EPCs) in patients with primary type 2 diabetes. Methods:Forty-ifve newly diagnosed type 2 diabetes hospitalized patients were selected through the inclusion and exclu-sion criteria. The age, gender, height, weight, waist circumference and calculated body mass index (BMI) were recorded for each patient. The level of fasting blood glucose (FPG), fasting insulin (FINS), 2 hour postprandial blood glucose (PPG), glycosylated hemoglobin (HbA1c), triglyceride (TG), cholesterol (TC), high density lipo-protein (HDL) and low density lipoprotein (LDL) were measured. The newly diagnosed type 2 diabetes mellitus patients (mentioned above) were randomly divided into three groups according to the different hypoglycemic treatment. group A (n=15):patients were treated with twice per day of premixed insulin therapy (Humalog 25 pin) after 2 weeks of subcutaneous insulin pump therapy (CSII insulin aspart). group B (n=15):patients were treated with oral hypoglycemic drug (Diamicron MR 30-120 mg/d);group C (n=15):patients were treated with premixed insulin (Humalog 25 pin twice perday). After determination of general clinical data, the level of EPCs labled with CD34 and KDR double positive before and after 4 weeks of treatment were measured with lfow cy-tometry. The number of EPCs before and after treatment and three groups after 4 weeks treatment were compared to investigate the short-term effects of different hypoglycemic therapy effects of intensive treatment in newly diagnosed type 2 diabetic patients on the number of EPCs. Results:The clinical indexes and the number of EPCs in the A, B, C three groups showed no difference before treatment (P>0.05). However, treatment signiifcantly increased the number of EPCs in A.C groups was higher than B group after 4 weeks treatment. However no difference observed between A and C group. Meanwile, the number of EPCs and HbA1c had obvious negative linear correlation through mulitiple linear regression analysis. Conclusion:Altogether, these results suggest that the insulin strengthening treatment is better for newly diagnosed patients with type 2 diabetes mellitus. This treat-ment can relief of“glucotoxicity”rapidly and increase the number of EPCs, which may alleviate the endothelial dysfunction induced by diabetes and may prevent or delay the diabetes chronic vascular complication incidence. Meanwile, the level of blood glucose has a direct impact on the number of EPCs in patients of diabetes. Our re-sult is consistant with published reported that the higher HbA1c usually accompany with the less the number of EPCs in diabetes.
