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目的:探讨艾塞那肽对不同病程2型糖尿病患者的疗效。方法:56例2型糖尿病患者按病程分为A、B组,A组32例,病程1年以内;B组24例,病程1～7年。2组患者发生酮症或空腹血糖>13.9mmol·L-1时给予胰岛素静脉滴注,血糖下降至<10mmol·L-1时改为持续皮下注射胰岛素强化治疗,纠正酮症或酮症酸中毒后改为胰岛素多次皮下注射;待血糖稳定后2组均皮下注射艾塞那肽3个月,第1个月5μg,bid,第2、3个月10μg,bid。如果空腹血糖<6mmol·L-1,胰岛素减量1～2U。比较2组治疗前、后肝肾功能、糖化血红蛋白(HbAlc)、血脂、72h动态血糖、静脉葡萄糖耐量试验等的变化。结果:治疗3个月后,A组体重指数、血压明显下降,治疗前、后比较差异有统计学意义(P<0.05),B组与治疗前比较差异无统计学意义(P>0.05);治疗3个月后,A组胰岛素用量减少,治疗前、后比较差异有统计学意义(P<0.05),B组与治疗前比较差异无统计学意义(P>0.05);治疗3个月后,2组空腹C肽、餐后2hC肽有升高趋势,总胆固醇、低密度脂蛋白有下降趋势,高密度脂蛋白有升高趋势,但差异无统计学意义(P>0.05)。结论:艾塞那肽治疗可降低2型糖尿病患者体重、血压,对病程1年以内患者效果更明显,并有望保护胰岛B细胞功能、调节血脂。
Objective: To investigate the efficacy of exenatide in patients with type 2 diabetes mellitus with different course of disease. Methods: 56 patients with type 2 diabetes were divided into groups A and B according to the course of the disease, 32 cases in group A, the course of which was within 1 year; 24 cases in group B, with a course of 1 to 7 years. Insulin intravenous drip was given to ketosis group or fasting blood glucose> 13.9mmol·L-1 in 2 groups. When the blood glucose dropped to <10mmol·L-1, the patients were treated with continuous subcutaneous insulin instillation therapy to correct ketosis or ketoacidosis Subsequent to the insulin subcutaneous injection; to be stable blood glucose after 2 groups were subcutaneous injection of exenatide 3 months, the first month of 5μg, bid, 2,3 months of 10μg, bid. If fasting blood glucose <6mmol · L-1, insulin reduction 1 ~ 2U. The changes of liver and kidney function, HbAlc, blood lipid, 72h dynamic glucose, venous glucose tolerance test before and after treatment were compared between the two groups. Results: The body mass index and blood pressure of group A decreased obviously after 3 months of treatment, there was significant difference before and after treatment (P <0.05). There was no significant difference between group B and before treatment (P> 0.05). After 3 months of treatment, the amount of insulin in group A decreased, there was a significant difference between before and after treatment (P <0.05), but there was no significant difference between group B and before treatment (P> 0.05) (P> 0.05). The fasting C-peptide and 2-hour postprandial C peptide showed an increasing tendency in both groups. The total cholesterol and low-density lipoprotein tended to decline, and the high-density lipoprotein tended to rise. However, the difference was not statistically significant (P> 0.05). Conclusion: Exenatide treatment can reduce the body weight and blood pressure in patients with type 2 diabetes, the effect is more obvious in patients with disease within 1 year and is expected to protect islet B cell function and regulate blood lipid.