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目的比较速效胰岛素类似物门冬胰岛素和中性可溶性人胰岛素在初诊2型糖尿病患者胰岛素泵强化治疗中的作用差异。方法59例初诊2型糖尿病患者,男35例,女24例,年龄51岁±12岁,体重指数25kg/m2±3kg/m2,随机使用速效胰岛素类似物门冬胰岛素(类似物组,30例)和中性可溶性人胰岛素(人胰岛素组,29例),进行2周的胰岛素泵治疗。比较两组治疗中空腹及餐后血糖下降速度、程度,所需胰岛素剂量及低血糖事件的差异;比较泵治疗前后两组胰岛β细胞功能改善程度的差异。结果在胰岛素泵治疗第2天,类似物组早晚餐后2h血糖即明显低于人胰岛素组(8·4mmol/L±2·8mmol/L比11·3mmol/L±3·8mmol/L,9·0mmol/L±2·4mmol/L比10·7mmol/L±2·8mmol/L,P<0·05),至第7天类似物组空腹和午餐后2h血糖降低程度也明显大于人胰岛素组(4·6mmol/L±0·8mmol/L比5·3mmol/L±0·9mmol/L,7·3mmol/L±2·2mmol/L比8·1mmol/L±1·8mmol/L,P<0·05)。治疗第14天,则只有空腹血糖存在差异;停止治疗后,空腹和早晚餐后2h血糖在两组间差异仍有统计学意义。类似物组获理想血糖控制时间短于人胰岛素组(2·0d比6·0d,P<0·01),所需胰岛素剂量又较小(0·6U/kg比0·8U/kg,P=0·002)。泵治疗前后胰岛β细胞功能指标如静脉葡萄糖耐量试验中胰岛素急性分泌时相、胰岛素和C肽曲线下面积,Homaβ,胰岛素原在两组间差异无统计学意义。治疗中两组仅见轻度低血糖事件:类似物组8例次(27%),人胰岛素组10例次(35%)。结论速效胰岛素类似物门冬胰岛素用于初诊2型糖尿病患者胰岛素泵强化治疗,和人胰岛素相比,可更快更好地改善空腹和餐后血糖,但对胰岛β细胞功能改善程度,差异无统计学意义。
Objective To compare the effects of fast acting insulin analogue aspart insulin and neutral soluble human insulin on insulin pump intensive treatment in newly diagnosed type 2 diabetic patients. Methods A total of 59 newly diagnosed type 2 diabetic patients, 35 males and 24 females, aged 51 years and 12 years old with a body mass index of 25 kg / m2 ± 3 kg / m2, were randomly assigned to receive insulin aspart aspart insulin (analogue group, 30 patients ) And neutral soluble human insulin (human insulin group, 29 cases) were treated with insulin pump for 2 weeks. The fasting blood glucose and postprandial blood glucose declining rate, the degree of insulin dosage and the incidence of hypoglycaemia were compared between the two groups. The difference of the function of pancreaticβcells before and after treatment was compared. Results On the second day after insulin pump treatment, the blood glucose of the analogue group was significantly lower than that of the human insulin group 2h after breakfast and dinner (8.4 mmol / L ± 2.8 mmol / L vs 11.3 mmol / L ± 3.8 mmol / L, 9 · 0 mmol / L ± 2 · 4 mmol / L vs 10 · 7 mmol / L ± 2 · 8 mmol / L, P <0 · 05). On the 7th day, the hypoglycemia in fasting group and 2h after lunch group were significantly higher than that of human insulin Group (4.6 mmol / L ± 0.8 mmol / L vs 5.3 mmol / L ± 0.9 mmol / L, 7.3 mmol / L ± 2.2 mmol / L vs 8.1 mmol / L ± 1.8 mmol / L, P <0 · 05). On the 14th day of treatment, there was only difference in fasting blood glucose; after stopping treatment, there was still a significant difference between the two groups in fasting and 2h after breakfast. Compared with the human insulin group (2.0d vs 6.0d, P <0.01), the analogue group had a shorter duration of glycemic control than the human insulin group (0.6U / kg vs. 0.8U / kg, P = 0 · 002). Pumps before and after treatment of pancreatic β-cell function indicators such as intravenous glucose tolerance test acute phase of insulin secretion, insulin and C-peptide area under the curve, Homaβ, proinsulin in the two groups was no significant difference. In the treatment group, only mild hypoglycemic events were seen in both groups: 8 in the analogue group (27%) and 10 in the human insulin group (35%). Conclusion Insulin analogues insulin aspart is used in insulin pump therapy in newly diagnosed type 2 diabetic patients. Compared with human insulin, fasting and postprandial blood glucose can be improved faster and better, but the degree of improvement of islet β-cell function is not significant Statistical significance.