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目的探讨胰岛素强化治疗对初诊2型糖尿病(T2DM)患者胰腺β细胞及血管内皮细胞功能的影响。方法选取初诊T2DM患者196例,随机分为观察组(n=98)与对照组(n=98)。对照组给予口服降糖药治疗,观察组给予胰岛素强化治疗,即于早、中、晚餐15 min前皮下注射门冬胰岛素,睡前皮下注射甘精胰岛素,总疗程均为8周。于治疗前后观察两组患者的血糖、HbA1c和胰岛素水平,计算胰腺β细胞功能指数(Homa-β)和胰岛素抵抗指数(HomaIR),检测血清一氧化氮(NO)和内皮素(ET),超声测定内皮依赖性血管舒张功能(FMEDD)和非内皮依赖性舒张功能(NIEID)。结果治疗后,两组FBG、2hPPG、HbA1c、Homa-IR、ET水平均降低,Homa-β、NO均增高(P<0.05或P<0.01);且观察组FBG、2hPPG、HbA1c、Homa-IR、ET水平均低于对照组,Homa-β、NO、FMEDD高于对照组(P<0.05),血糖达标时间少于对照组(P<0.05)。结论短期速效胰岛素联合长效胰岛素强化治疗初诊T2DM有效控制了血糖水平,保护了胰腺β细胞及血管内皮细胞功能,对控制T2DM进展和并发症的发生具有积极的作用。
Objective To investigate the effects of intensive insulin therapy on the function of pancreatic β cells and vascular endothelial cells in newly diagnosed type 2 diabetes mellitus (T2DM). Methods 196 newly diagnosed T2DM patients were randomly divided into observation group (n = 98) and control group (n = 98). The control group was treated with oral hypoglycemic agents. The observation group was given intensive insulin therapy. The insulin aspart was injected subcutaneously 15 minutes before breakfast, dinner, and insulin glargine subcutaneously at bedtime. The total duration of treatment was 8 weeks. Blood glucose, HbA1c and insulin levels were measured before and after treatment. Homa-β and HomaIR were calculated, serum nitric oxide (NO) and endothelin (ET) Endothelium-dependent vasodilation (FMEDD) and non-endothelium-dependent diastolic function (NIEID) were determined. Results After treatment, the levels of FBG, 2h PPG, HbA1c, Homa-IR and ET in both groups were decreased and the levels of Homa-β and NO were increased (P <0.05 or P <0.01) , ET levels were lower than the control group, Homa-β, NO, FMEDD was higher than the control group (P <0.05), blood glucose compliance time less than the control group (P <0.05). Conclusion Short-term fast-acting insulin combined with long-acting insulin-intensive therapy for newly diagnosed T2DM effectively controls blood glucose levels and protects the function of pancreatic β-cells and vascular endothelial cells, which plays a positive role in controlling the progression of T2DM and complications.