早期胰岛素泵强化治疗对初诊2型糖尿病患者远期颈动脉粥样硬化及降糖方案的影响

发布时间：2018-01-13 07:20

  本文关键词：早期胰岛素泵强化治疗对初诊2型糖尿病患者远期颈动脉粥样硬化及降糖方案的影响　出处：《山西医科大学》2016年硕士论文　论文类型：学位论文

  更多相关文章： 胰岛素泵 2型糖尿病 颈动脉粥样硬化 颈动脉内膜-中膜厚度

【摘要】：目的:本研究回访初诊使用胰岛素泵降糖或口服降糖药的2型糖尿病(T2DM)患者,观察早期胰岛素泵(CSII)降糖对初诊T2DM患者远期颈动脉粥样硬化(AS)的影响,观察初诊时胰岛素泵治疗对远期胰岛功能的作用,探讨初诊降糖方式与远期血糖控制水平、降糖治疗方案的关系,为初诊糖尿病患者预防远期大血管并发症、长期有效控制血糖提供理论依据。方法:回顾性研究2002年~2010年于北京军区总医院内分泌科初诊T2DM患者,依据病历系统查阅入院病历,2014年~2015年对符合纳入标准患者进行回访,共回访患者531位。根据初诊有无应用胰岛素泵分为强化(CSII)组273例和口服降糖药(OAD)组258例。回访时检测一般临床资料,详细询问患者近3个月降糖方案,并用B型超声观察颈动脉血管内膜-中膜厚度(IMT)、血管病变情况等指标。比较两组间一般临床资料、颈动脉IMT、斑块阳性率、胰岛功能有无差异,分析两组药物治疗情况及血糖控制状况,同时对颈动脉粥样硬化的影响因素进行分析。结果:1.分析初诊资料,比较年龄、男女比例、病程、血压(SBP/DBP)、体质指数(BMI)、血脂指标、空腹血糖(FPG)、空腹胰岛素(FINS)、胰岛素抵抗指数(H0MA-IR)、胰岛β细胞功能(H0MA-β)、CIMT、斑块阳性率,差异均无统计学意义(P0.05)。强化组(CSII)糖化血红蛋白(HbA1c)高于口服药(OAD)(P0.05)。531位初诊T2DM患者颈血管斑块阳性率是29.00%。强化组(CSII)颈斑块阳性率达29.67%,口服药组(OAD)颈斑块阳性率达到28.29%。2.分析回访时检测指标,强化组年龄、男女比例、病程、血压(SBP/DBP)、BMI、TC、TG、HDL-C、LDL-C、FPG、HbA1c与非强化组比较均未见明显差别(p0.05)。回访时患者糖尿病平均病程为(8.98±2.57)年,其中回访观察最小时限为5年,最大时限为13年。3.比较回访时两组颈血管硬化指标,强化组(csii)cimt值为(0.72±0.28)mm,口服药组(oad)颈动脉imt值为(0.77±0.25)mm,存在统计学差别(p0.05);颈动脉斑块阳性率强化组(csii)是40.29%,口服药组(oad)是49.61%,比较两组斑块阳性率存在统计学差异(p0.05)。4.比较回访时fpg、hba1c、h0ma-ir(cp)、h0ma-β(cp),两组fpg、hba1c、h0ma-ir(cp)均无统计学差异(p0.05)。强化组h0ma-β(cp)优于口服药组(p=0.012)。以hba1c≤6.5%作为血糖良好控制的切点,强化组达标率为22.71%;口服药组(oad)达标率是14.34%,两组间血糖良好降低的达标率存在统计学差异(p=0.013)。5.初诊时强化组经短期csii治疗后,t2dm患者无药缓解为118位,比率是43.22%;患者服用1种降糖药的百分比达44.69%,联合2种口服药百分比达12.09%。口服药组(oad)采用短期单纯口服降糖药治疗后,应用1种口服降糖药治疗比率为79.07%,2种口服药联合使用的比率为16.28%,无药缓解的患者比例为4.65%。6.回访时强化组无药缓解的比率为5.13%,单纯口服药治疗为63.37%,口服药联合胰岛素治疗者为27.84%,仅使用胰岛素比例为3.66%。非强化组患者均需使用药物降糖,单纯口服药治疗为55.43%,口服降糖药联合胰岛素为24.03%,单纯使用胰岛素百分比达20.54%。各组间降糖药物治疗方式的组成比不全相同(p0.01)。7.对回访时cimt与各观察值实行相关分析:imt与年龄、hba1c、homa-ir、ldl-c呈显著正相关,与homa-β呈负相关。结论:1.初诊2型糖尿病患者约29.00%合并颈动脉粥样硬化。提示2型糖尿病患者初诊时可能并发大血管病变,应早期诊断及时治疗。2.初诊2型糖尿病患者早期应用胰岛素泵强化治疗可以降低远期cimt,可能延缓糖尿病颈动脉粥样硬化大血管病变的发生。3.初诊2型糖尿病患者经胰岛素泵强化治疗后长期胰岛β细胞功能改善优于初诊口服降糖药患者。4.初诊2型糖尿病患者早期强化治疗可影响远期降糖治疗方案,部分患者可获得长期临床缓解状态。
[Abstract]:Objective: This study revisits the use of hypoglycemic or oral antidiabetic drugs in newly diagnosed type 2 diabetes insulin pump (T2DM) patients, to observe the early insulin pump (CSII) on T2DM in patients with long-term diabetes carotid atherosclerosis (AS) effect of initial observation of insulin pump therapy on long-term islet function of newly diagnosed hypoglycemic and long-term blood glucose the level of control, hypoglycemic therapy for newly diagnosed diabetic patients, long-term prevention of macrovascular complications, long-term effective control of blood glucose and provide a theoretical basis. Methods: review of newly diagnosed T2DM patients in Department of endocrinology of General Hospital of Beijing Military Region on 2002 ~2010, according to medical records system access to medical records, 2014 ~2015 years to meet the inclusion criteria were a total of 531 patients with follow-up visit according to the diagnosis. There is no insulin pump divided into intensive (CSII) group and 273 cases of oral antidiabetic drugs (OAD) group of 258 cases. When the visit. Measuring the general clinical data, patients were asked in detail about the nearly 3 months of treatment, and the use of B ultrasonography to observe the carotid artery intima-media thickness (IMT), vascular disease and other indicators were compared between the two groups. The general clinical data, carotid artery IMT, plaque positive rate, there is no difference in islet function, analysis two drug treatment group and the control of blood glucose, and the influence factors of carotid atherosclerosis were analyzed. Results: 1. analysis of diagnostic data, age, sex ratio, disease duration, blood pressure (SBP/DBP), body mass index (BMI), blood lipid, fasting blood glucose (FPG), fasting insulin (FINS), insulin resistance index (H0MA-IR), islet beta cell function (H0MA-), CIMT, the positive rate of plaque, there were no significant differences (P0.05). The intensive group (CSII) of glycosylated hemoglobin (HbA1c) was higher than that of oral medicine (OAD) (P0.05) the positive rate of.531 T2DM in patients with carotid plaque 29.00%. augmentation group (CSII)棰堟枒鍧楅槼鎬х巼杈，

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