二甲双胍治疗儿童胰岛素抵抗的疗效观察

发布时间：2018-09-11 12:58

【摘要】：目的：随着人们生活水平的提高及生活方式的改变,儿童胰岛素抵抗的发病率呈明显上升趋势,儿童的胰岛素抵抗已经成为全世界医生及患儿家属尤为关心的问题。胰岛素抵抗（insulin resistance,IR）是糖耐量异常、向心性肥胖、脂质代谢紊乱，高血压、高尿酸血症，2型糖尿病，心脏病，代谢综合症，纤溶异常，甚至是育龄期妇女的多囊卵巢综合症（PCOS）等多种疾病的病理生理的基础。研究报道我国城市学龄儿童肥胖的发生率已达10%-20%,肥胖儿童中胰岛素抵抗的发病率约50%[1],随着儿童肥胖和2型糖尿病的增加,以及儿童肾病综合征等疾病糖皮质激素应用的过程中所致的胰岛素抵抗的副作用亦越来越明显,因此儿童胰岛素抵抗已经成为临床亟需解决的问题。如果我们能够早期发现，早期诊断，并给予早期治疗，则会使其成年时期相关疾病的发病率减少。本文通过对大连医科大学附属二院儿科收治的部分胰岛素抵抗的患儿，给予二甲双胍口服治疗，观察二甲双胍对于存在胰岛素抵抗的患儿的疗效，用药过程中注意观察其不良反应并及时给予治疗。方法：本文通过选择大连医科大学附属第二医院儿科自2007年1月-2011年12月收治的确诊有胰岛素抵抗（IR）的患儿24例，其中单纯性肥胖患儿10例，肾病综合征应用糖皮质激素治疗过程中所致胰岛素抵抗的患儿14例，所有患儿均给予二甲双胍口服治疗12周，观察患儿治疗前后空腹血糖，胰岛素，血脂等指标的变化，计算胰岛素抵抗指数（HOMA—IR)，从而评估二甲双胍对于胰岛素抵抗的疗效，用药过程中注意监测患儿是否出现胃肠道反应，皮疹等不良反应并及时调整药物剂量及予以对症处理。结果：口服二甲双胍组治疗l2周后与治疗前相比，患儿的体质指数由治疗前的（25.5±2.1）降到治疗后的（23.8±1.48）,TG由治疗前的（2.01±1.10）mmol/L降至治疗后的（1.43±0.48）mmol/L，LDL-L由治疗前的（3.30±0.57）mmol/L降至治疗后的（2.75±0.44）mmol/L；口服二甲双胍治疗12周后与治疗前比较，患儿的体重，体质指数，TG及LDL-L均下降,与治疗前相比，差异具有统计学意义(P0.05)。口服二甲双胍组治疗l2周后与治疗前相比，血糖由治疗前的(5.5±0.3)mmol/L降到治疗后的(4.6±0.4)mmol/L，胰岛素水平由治疗前的(29.7±4.0)IU/ml降至治疗后的(15.4±4.4)IU/ml，，胰岛素抵抗指数由治疗前的(4.3±1.5)降至治疗后的(3.1±1.6)；口服二甲双胍组治疗l2周后与治疗前相比，患儿的血糖，血胰岛素水平，胰岛素抵抗指数值明显下降，治疗前后比较，差异具有统计学意义（P0.05）。本研究中，24例伴有胰岛素抵抗的患儿均给予二甲双胍治疗12周，其中有18例（75％）患儿的胰岛素抵抗指数恢复正常，体重较前明显下降；所有服用二甲双胍的患儿均没有出现过敏、贫血等严重不良反应，仅有5例（21％）患儿有腹部不适和腹泻的胃肠道症状,无其他不适症状，但患儿是可以耐受的。结论：二甲双胍可以改善葡萄糖代谢异常，降低体重和体脂，改善胰岛素抵抗；二甲双胍对于防治激素诱导的肥胖相关性肾病及单纯性肥胖所致的胰岛素抵抗具有重要意义。
[Abstract]:OBJECTIVE: With the improvement of people's living standard and the change of life style, the incidence of insulin resistance in children is increasing obviously. Insulin resistance in children has become a special concern of doctors and family members all over the world. Insulin resistance (IR) is an abnormal glucose tolerance, centripetal obesity and turbulent lipid metabolism. Chaos, hypertension, hyperuricemia, type 2 diabetes, heart disease, metabolic syndrome, fibrinolytic abnormalities, and even polycystic ovary syndrome (PCOS) in women of childbearing age are the pathophysiological basis of various diseases. With the increase of childhood obesity and type 2 diabetes mellitus, and the side effects of insulin resistance caused by glucocorticoid therapy in children with nephrotic syndrome, insulin resistance in children has become an urgent clinical problem. In this paper, metformin was given orally to some children with insulin resistance admitted to the Department of Pediatrics, Second Affiliated Hospital of Dalian Medical University, to observe the efficacy of metformin in the treatment of children with insulin resistance, and to observe its adverse reactions in the course of medication. Give treatment.
Methods: From January 2007 to December 2011, 24 children with insulin resistance (IR) were selected from the Department of Pediatrics, the Second Affiliated Hospital of Dalian Medical University. Among them, 10 were simple obese, 14 were nephrotic syndrome patients with insulin resistance induced by glucocorticoid therapy, and all were given dimethylbismuth. After 12 weeks of guanidine oral therapy, the changes of fasting blood glucose, insulin and blood lipid were observed before and after treatment, and the insulin resistance index (HOMA-IR) was calculated to evaluate the effect of metformin on insulin resistance. Symptomatic treatment should be given.
Results: Compared with before treatment, the BMI of the children in the oral metformin group decreased from (25.5 6550 After 12 weeks of metformin treatment, the body weight, body mass index, TG and LDL-L of the children were decreased compared with those before treatment, and the difference was statistically significant (P 0.05).
In the oral metformin group, blood glucose decreased from (5.5 + 0.3) mmol/L before treatment to (4.6 + 0.4) mmol/L after treatment, insulin level decreased from (29.7 + 4.0) IU/ml before treatment to (15.4 + 4.4) IU/ml after treatment, and insulin resistance index decreased from (4.3 + 1.5) before treatment to (3.1 + 1.6) after treatment. Compared with those before treatment, the levels of blood glucose, insulin and insulin resistance index in guanidine group decreased significantly after treatment for L2 weeks, and the difference was statistically significant (P 0.05).
In this study, 24 children with insulin resistance were treated with metformin for 12 weeks, of which 18 (75%) had normal insulin resistance index and significantly reduced body weight; all the children taking metformin had no serious adverse reactions such as allergy, anemia, and only 5 (21%) had abdominal discomfort and abdominal discomfort. Diarrhoea gastrointestinal symptoms, no other symptoms, but children are tolerable.
CONCLUSION: Metformin can improve glucose metabolism, reduce body weight and fat, and improve insulin resistance. Metformin is of great significance in preventing and treating hormone-induced obesity-related nephropathy and insulin resistance induced by simple obesity.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R725.8;R96

【参考文献】