论文部分内容阅读
目的:观察比较胰岛素重度分泌不足伴不同程度胰岛素抵抗的2型糖尿病(T2DM)患者的临床特征、治疗方案及预后。方法:选择胰岛素重度分泌不足伴胰岛素抵抗的T2DM 119例,按照胰岛素抵抗程度分为A组即胰岛素重度分泌不足伴轻度抵抗58例、B组即胰岛素重度分泌不足伴重度抵抗61例。比较两组血糖、血脂、体质指数(BMI)、腰臀比(WHR)、胰岛B细胞分泌功能、存在并发症和合并症情况、治疗方案及疗效。结果:两组糖尿病相关并发症发生率差异不显著(P>0.05);A组合并冠心病、脑血管事件、高血压病、脂肪肝、高尿酸血症比例均显著或非常显著低于B组(P<0.05,P<0.01)。治疗3个月后,两组空腹血糖(FPG)、餐后2h血糖(2hPG)、糖化血红蛋白(HbA1c)均较治疗前显著降低(P<0.05),两组间FPG、2hPG、HbA1c均差异不显著(P>0.05)。治疗前,B组总胆固醇、三酰甘油、低密度脂蛋白胆固醇、BMI均显著高于A组(P<0.05);治疗后,B组BMI显著高于A组(P<0.05),WHR显著低于A组(P<0.05),两组血脂水平比较差异不显著(P>0.05)。治疗后,两组胰岛素峰值(PINS)、胰岛素峰值与基础值比值(Ip/Io)、C肽峰值(Pc-p)、C-肽峰值与基础值比值(Cp/Co)均较治疗前显著好转(P<0.05);B组PINS、Ip/Io、Pc-p、Cp/Co均显著高于A组(P<0.05)。结论:根据胰岛素抵抗程度对T2DM患者进一步细化诊断分级并拟定不同的治疗预案,在临床具有可行性和必要性。
Objective: To observe and compare the clinical features, treatment and prognosis of patients with type 2 diabetes mellitus (T2DM) with inadequate insulin secretion and insulin resistance. Methods: One hundred and ninety-two T2DM patients with severe insulin secretion and insulin resistance were divided into two groups according to the degree of insulin resistance: group A, which had mild insulin secretion and mild resistance, and group B, insulin deficiency severe and insulin resistance. Blood glucose, blood lipids, body mass index (BMI), WHR, pancreatic B cell secretory function, complications and complications, treatment and efficacy were compared between the two groups. Results: The incidence of complications related to diabetes was not significantly different between the two groups (P> 0.05). The proportions of coronary heart disease, cerebrovascular disease, hypertension, fatty liver and hyperuricemia in group A were significantly or very significantly lower than those in group B (P <0.05, P <0.01). After 3 months of treatment, FPG, 2hPG and HbA1c in both groups were significantly lower than those before treatment Significant (P> 0.05). Before treatment, total cholesterol, triglyceride, low density lipoprotein cholesterol and BMI in group B were significantly higher than those in group A (P <0.05). After treatment, BMI in group B was significantly higher than that in group A (P <0.05) Lower than that in group A (P <0.05). There was no significant difference in lipid levels between the two groups (P> 0.05). After treatment, the peak values of PINS, Ip / Io, Pc-p and Cp / Co between the two groups were significantly higher than those before treatment (P <0.05). The levels of PINS, Ip / Io, Pc-p and Cp / Co in group B were significantly higher than those in group A (P <0.05). Conclusion: According to the degree of insulin resistance, the further classification and classification of T2DM patients and the preparation of different treatment plans are feasible and necessary in clinic.