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目的通过观察短期内利拉鲁肽与强化胰岛素治疗2型糖尿病患者前后空腹、60、120、180 min C-肽的变化,比较两种治疗方法对初发2型糖尿病患者胰岛β细胞功能的影响。方法选取2012年3月—2013年10月住院的初发2型糖尿病患者,并随机分为利拉鲁肽组和强化胰岛素组,利拉鲁肽组初始剂量为0.6 mg/d,每周加量0.6 mg,最大剂量为1.8 mg/d,强化胰岛素组起始剂量为0.5 U/(kg·d),根据血糖变化调整剂量,治疗20 d,于治疗前、后分别做口服葡萄糖耐量试验并测定C-肽释放曲线,将结果进行数据分析,计量资料采用t检验,计数资料采用χ2检验,P<0.05为差异有统计学意义。结果两组患者治疗20 d后,强化胰岛素组患者的血糖达标时间为(7.2±2.1)d,优于利拉鲁肽组的(10.1±2.6)d,对比差异有统计学意义(P<0.05),治疗后利拉鲁肽组患者在60、120、180 min的C-肽分别进行(4.21±0.97)、(7.14±1.12)、(5.38±1.08)nmol/L,均高于强化胰岛素组相应时间点的(3.57±0.98)、(6.56±0.95)、(4.95±1.02)nmol/L,对比差异均有统计学意义(均P<0.05)。治疗过程中利拉鲁肽组患者无低血糖事件发生。结论短期治疗时,在改善胰岛β细胞功能方面,利拉鲁肽治疗要优于强化胰岛素降糖治疗,更有利于长期血糖控制,同时具有良好的安全性。
OBJECTIVE: To observe the changes of fasting, 60,120,180 min C-peptide in patients with type 2 diabetes treated with liraglutide and intensive insulin in the short term and compare the effects of these two treatments on the function of pancreatic β-cells in patients with newly diagnosed type 2 diabetes . Methods Patients with newly diagnosed type 2 diabetes admitted to hospital from March 2012 to October 2013 were randomly divided into liraglutide group and intensive insulin group. The initial dose of liraglutide was 0.6 mg / d, 0.6 mg, the maximum dose of 1.8 mg / d, the initial dose of intensive insulin 0.5 U / (kg · d), according to the blood glucose to adjust the dose for 20 days, before treatment, respectively, after oral glucose tolerance test and determination of C - peptide release curve, the results of data analysis, measurement data using t test, count data using the χ2 test, P <0.05 for the difference was statistically significant. Results The blood glucose level of intensive insulin group was (7.2 ± 2.1) days after treatment for 20 days in both groups, which was significantly better than that in liraglutide group (10.1 ± 2.6) days, the difference was statistically significant (P <0.05 ), The C-peptide levels in the liraglutide group were (4.21 ± 0.97), (7.14 ± 1.12) and (5.38 ± 1.08) nmol / L at 60,120,180 min after treatment, respectively, which were higher than those in the intensive insulin group The corresponding time points were (3.57 ± 0.98), (6.56 ± 0.95) and (4.95 ± 1.02) nmol / L, respectively. The differences were statistically significant (all P <0.05). No hypoglycemic events occurred in the liraglutide group during treatment. Conclusion In short-term treatment, liraglutide is superior to intensive insulin-lowering hypoglycemic therapy in improving pancreatic β-cell function, which is more beneficial to long-term glycemic control and has good safety.