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目的观察瑞格列奈、己酮可可碱、睡前诺和灵N联合治疗对伴有明显高血糖和高甘油三酯血症的初诊Ⅱ型糖尿病(T2DM)患者的血糖、血脂和胰岛β细胞功能的影响。方法对空腹血糖大于11.1mmol/L的53例初诊Ⅱ型糖尿病患者进行为期2周的住院治疗,使血糖达标后出院。出院后继续原治疗3个月,分析比较其治疗前后空腹及餐后2小时血糖、糖化血红蛋白(HbA1c)、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、由Homa模型计算的Homa-β、Homa-IR等。血浆胰岛素、C肽采用放免法测定。结果联合治疗显示出快速稳定的降血糖效果。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分钟内出现了明显增加的胰岛素、C肽分泌相,相对应的每一点的血糖均较治疗前显著下降;胰岛素、C肽曲线下面积和由Homa模型计算的Homa-β均较治疗前明显提高;Homa-IR指数也较治疗前明显下降。结论瑞格列奈、己酮可可碱和睡前诺和灵N联合治疗对初诊Ⅱ型糖尿病患者能改善第一时相胰岛素分泌,可作为对初诊Ⅱ型糖尿病患者初始可行性治疗之一。
Objective To observe the effects of repaglinide, pentoxifylline and nocturnal injection of norepinephrine on blood glucose, lipids and islet β-cells in newly diagnosed type 2 diabetes mellitus (T2DM) patients with obvious hyperglycemia and hypertriglyceridemia Effect of function. Methods A total of 53 cases of newly diagnosed type 2 diabetic patients whose fasting blood glucose was more than 11.1mmol / L were hospitalized for two weeks, and their blood glucose was discharged before discharge. After 3 months of treatment, the patients were treated with HbA1c, IVGTT for fasting and postprandial insulin for 2 hours, and the area under the curve of insulin and C-peptide Homa-beta, Homa-IR calculated from the Homa model, and the like. Plasma insulin, C peptide using radioimmunoassay. Results Combination therapy showed a rapid and stable hypoglycemic effect. Islet β-cell function was significantly improved after treatment: intravenous glucose increased significantly within 10 minutes of insulin, C peptide secretion phase, corresponding to each point of the blood glucose were significantly lower than before treatment; insulin, C-peptide curve Area and Homa-β calculated by Homa model were significantly higher than before treatment; Homa-IR index also decreased significantly compared with before treatment. Conclusion The combination of repaglinide, pentoxifylline and nocturnal administration of norepinephrine can improve the first phase insulin secretion in newly diagnosed type 2 diabetic patients and may be one of the initial feasible treatments for newly diagnosed type 2 diabetic patients.