二甲双胍干预儿童肥胖高胰岛素血症的临床疗效分析

发布时间：2018-05-12 22:21

本文选题：二甲双胍 + 高胰岛素血症　；参考：《天津医科大学》2017年硕士论文

【摘要】：目的:探讨二甲双胍结合生活方式对肥胖高胰岛素血症非糖尿病儿童的临床效果。方法:回顾性分析2015年1月至2016年12月在天津医科大学总医院儿科内分泌门诊因肥胖就诊的儿童82名,其中男孩58例,女孩24例,年龄在8-16岁,平均年龄11.8±1.83岁,均符合肥胖及高胰岛素血症诊断标准,其中18例伴糖耐量减低(IGT)。所有儿童均给予调整饮食结构、增强运动的生活方式指导,同时口服二甲双胍片(格华止)0.5g,每日2次到3次,治疗1年。治疗前及治疗3个月、6个月、12个月时分别测量并计算各项临床指标[身高、体重、体重指数(BMI)、腰围(WC)、臀围、腰臀比(WHR)、腰围身高比(WHtR)],治疗前及治疗6个月、12个月时测定各项生化指标[空腹(0小时)及糖负荷后0.5小时,1小时,2小时,3小时时间点血糖、胰岛素水平,谷丙转氨酶(ALT)、谷草转氨酶(AST)等],并根据血糖、胰岛素水平计算胰岛功能相关指标(胰岛素抵抗指数、总体胰岛素敏感指数、胰岛细胞功能指数、早期胰岛素分泌指数,胰岛素曲线下面积),治疗前后进行自身对照,使用SPSS18.0软件,采用自身配对t检验,比较二甲双胍治疗前后各项指标的变化,P0.05为结果有统计学差异。治疗过程中密切观测不良反应,监测肝肾功能,及时调整用量。结果:1.口服二甲双胍1年,BMI由治疗前的30.81±4.49kg/m2降低为27.00±4.21kg/m2,治疗前后相比,差异具有统计学意义(P0.05);治疗后WC、WHR与初始相比降低,但3个月、6个月、12个月之间差别无统计学意义;与初始相比,WHtR降低,差别有统计学意义(P0.05),但6个月、12个月之间差别无统计学差异。2.口服二甲双胍治疗6个月时与治疗前相比,各时间点胰岛素水平均有明显的下降,6个月与12个月相比,空腹(0小时)、糖负荷后1小时、2小时胰岛素水平继续下降,差异有统计学意义(均P0.05),0.5h-INS、3h-INS差异无统计学意义(P0.05);糖负荷后2小时血糖由7.06±1.66mmol/L降低为6.52±1.40mmol/L,差别有统计学意义(P0.05)。3.二甲双胍治疗6个月后,胰岛素抵抗指数、胰岛细胞功能指数、胰岛素曲线下面积下降,总体胰岛素敏感指数升高(均P0.05),二甲双胍治疗12个月时胰岛素抵抗指数继续降低,总体胰岛素敏感指数继续升高(均P0.05),其余指标与6个月时无统计学差异;早期胰岛素分泌指数治疗前后无明显变化;黑棘皮病情况有不同程度的好转。4.二甲双胍干预1年后,18例IGT儿童有13例血糖恢复到正常水平,另外5例有不同程度的降低,糖负荷后2小时血糖显著降低(P0.05);5.二甲双胍治疗后ALT、AST有所降低(P0.05)。6.所有接受二甲双胍治疗的儿童仅有个别出现腹泻、腹部不适等胃肠道症状,通过调整可以耐受,均没有出现皮疹、低血糖、贫血等严重不良反应。结论:1.在调整饮食结构、加强运动的基础上,儿童肥胖高胰岛素血症患者每天服用二甲双胍1.0克到1.5克,为期1年,可使体重减轻。2.肥胖伴胰岛素抵抗儿童,在饮食及运动指导的基础上联合应用二甲双胍治疗1年疗效显著,降低胰岛素分泌量,改善胰岛素敏感性,减轻胰岛素抵抗。3.二甲双胍可促使IGT患者转为糖耐量正常,延缓糖耐量受损向2型糖尿病发展,改善肥胖非糖尿病儿童的糖代谢异常。4.盐酸二甲双胍减轻体重、改善胰岛素敏感性的同时,对改善肝酶有一定的效果。5.二甲双胍治疗肥胖非糖尿病儿童高胰岛素血症较为安全有效,耐受性良好,可有选择性的应用于临床治疗。
[Abstract]:Objective: To investigate the clinical effect of metformin combined with lifestyle on obesity and hyperinsulinemia non diabetic children. Methods: a retrospective analysis of 82 children in the pediatric endocrinology clinic of General Hospital Affiliated to Tianjin Medical University from January 2015 to December 2016 was reviewed. Among them, 58 boys, 24 girls, 8-16 years old, and the average age of 11.8 + 1. .83 years of age were all in accordance with the diagnostic criteria for obesity and hyperinsulinemia in Hefei, of which 18 cases were associated with impaired glucose tolerance (IGT). All children were given a diet structure to improve the lifestyle guidance, and oral metformin tablets (g) 0.5g, 2 to 3 times a day for 1 years. Before and for 3 months, 6 months, 12 months, the patients were measured and measured respectively. The clinical indicators [height, weight, body mass index (BMI), waist circumference (WC), hip circumference, waist to hip ratio (WHR), waist height ratio (WHtR)), preoperative and treatment 6 months, 12 months of biochemical indicators [fasting (0 hours) and sugar load 0.5 hours, 1 hours, 2 hours, 3 hours of blood glucose, insulin levels, ALT, cereal, cereal Aminotransferase (AST), and according to blood glucose and insulin level, calculate the islet function related index (insulin resistance index, total insulin sensitivity index, islet cell function index, early insulin secretion index, area under insulin curve), self control before and after treatment, use SPSS18.0 software, compare two with self matching test, compare two The changes of all indexes before and after treatment with metformin were statistically different in P0.05. During the treatment, the adverse reactions were observed closely, the function of liver and kidney was monitored and the dosage was adjusted in time. Results: 1. oral metformin was taken for 1 years, and the BMI was reduced to 27 + 4.21kg/m2 by 30.81 + 4.49kg/m2 before treatment, and the difference was statistically significant (P0.05) before and after treatment. WC and WHR decreased after treatment, but there was no statistical difference between 3 months, 6 months, and 12 months, and the difference was statistically significant (P0.05) compared with the initial period, but there was no statistical difference between 6 months and 12 months. The level of insulin at each time point was significantly higher than that before the treatment for 6 months after the treatment of oral metformin. The difference was statistically significant (all P0.05), and there was no statistically significant difference between 6 months and 12 months, 1 hours and 2 hours after sugar load (all P0.05), and there was no significant difference in 0.5h-INS and 3h-INS (P0.05), and 2 hours after sugar load decreased from 7.06 + 1.66mmol/L to 6.52 + 1.40mmol/L, and the difference was statistically significant (P0.05).3. two a. After 6 months of metformin treatment, the insulin resistance index, the islet cell function index, the area under the insulin curve decreased, the overall insulin sensitivity index increased (all P0.05). The insulin resistance index continued to decrease with metformin treatment for 12 months, the overall insulin sensitivity index followed Xu Shenggao (P0.05), and the other indexes were not statistically different from that of 6 months. There was no significant change in the early insulin secretion index before and after treatment; black acanthosis was improved in different degrees. After 1 years of.4. metformin intervention, 18 cases of IGT children had 13 cases of blood glucose recovery to normal level, the other 5 had different degrees of decrease, 2 hours after sugar load decreased significantly (P0.05); 5. after metformin treatment, ALT, AST decreased. Children with low (P0.05).6. were treated with metformin only with diarrhea, abdominal discomfort, gastrointestinal symptoms, tolerance, and no serious adverse reactions, such as rash, hypoglycemia, anemia and other adverse reactions. Conclusion: 1. children with obesity and hyperinsulinemia are taken daily on the basis of adjusting the diet structure and strengthening exercise. Metformin, 1 grams to 1.5 grams, lasts 1 years for weight loss of.2. obese children with insulin resistance. On the basis of diet and exercise guidance, combined use of metformin for 1 years is significant, reduces insulin secretion, improves insulin sensitivity, and reduces insulin resistance to.3. dimethyl metformin, which can lead to IGT patients to turn to normal glucose tolerance. To delay the impaired glucose tolerance to the development of type 2 diabetes, improve the glucose metabolism abnormality in obese non diabetic children,.4. hydrochloric acid metformin reduces weight, improves insulin sensitivity, and has a certain effect on improving liver enzymes..5. metformin is safe, effective, and well tolerated in the treatment of obese non diabetic children with hyperisomia. It is selectively applied to clinical treatment.

【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R723.14

【参考文献】