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目的:观察持续皮下胰岛素输注(CSII)对2型糖尿病(T2DM)微血管病变的影响。方法:80例T2DM微血管病变患者应用4周CSII强化治疗,比较治疗前后患者血清炎症因子:C-反应蛋白(CRP)、高敏C-反应蛋白(hsCRP);血清Ⅳ型胶原(CⅣ);纤溶因子:组织型纤溶酶原激活剂(t-PA)、组织型纤溶酶原激活剂抑制物(PAI-1)浓度的变化。结果:①T2DM微血管病变组患者CRP、hsCRP、CⅣ、PAI-1水平显著高于正常对照组(P<0.01),t-PA水平显著低于正常对照组(P<0.01)。②CSII治疗4周后空腹血糖、餐后2h血糖显著降低(P<0.01);糖化血红蛋白、胰岛素抵抗指数、CRP、hsCRP、CⅣ均降低(P<0.05);PAI-1显著降低(P<0.01),t-PA显著升高(P<0.01)。结论:T2DM微血管病变与血清炎症因子;CⅣ;纤溶因子有关,CSII治疗除能降血糖外,还能显著降低血清炎症因子、CⅣ水平,改善纤溶因子功能,减轻胰岛素抵抗。
Objective: To observe the effect of continuous subcutaneous insulin infusion (CSII) on the microangiopathy in type 2 diabetes mellitus (T2DM). Methods: Eighty patients with T2DM microangiopathy were treated with CSII for 4 weeks. Serum inflammatory factors C-reactive protein (CRP), high-sensitivity C-reactive protein (hsCRP), serum type Ⅳ collagen Factors: changes in tissue plasminogen activator (t-PA), tissue inhibitor of plasminogen activator (PAI-1) concentration. Results: ① The levels of CRP, hsCRP, CⅣ, PAI-1 in T2DM patients with microvascular disease were significantly higher than those in normal control group (P <0.01). The levels of t-PA were significantly lower than those in normal control group (P <0.01). (2) After 4 weeks of treatment, the fasting blood glucose (FBG) and 2h postprandial blood glucose decreased significantly (P <0.01); the HbAlc, insulin resistance index, CRP, hsCRP and CⅣwere all decreased , t-PA was significantly higher (P <0.01). CONCLUSIONS: T2DM microangiopathy is associated with serum inflammatory cytokines and CⅣ fibrinolysis. In addition to lowering blood glucose, CSII treatment can significantly reduce serum levels of inflammatory cytokines and CⅣ, improve fibrinolytic function and reduce insulin resistance.