利拉鲁肽联合胰岛素泵治疗非初诊2型糖尿病的临床疗效观察

发布时间：2018-04-28 21:22

本文选题：利拉鲁肽 + 胰岛素泵　；参考：《延安大学》2015年硕士论文

【摘要】：目的:观察利拉鲁肽与胰岛素泵联合应用对非初诊2型糖尿病患者在控制血糖水平及减轻体重等方面治疗前后的改善情况。评估两药联合作用于非初诊2型糖尿病患者的临床效果,以期寻找更有效的降糖方案及合适的临床剂量,为提高治疗非初诊2型糖尿病患者的临床效果并减轻药物的不良反应提供理论和实验依据。方法:1.选择2013年1月~2015年1月在延安大学附属医院东关分院综合内科及榆林市中医医院北方医院内分泌科收治的45例非初诊2型糖尿病患者,所有患者均进行糖尿病饮食、适量运动,研究期间禁用其它降糖药物及影响诺和力活性成分的药物。2.选取此45例患者随机分为两组,对照组21例,实验组24例。对照组:在饮食运动的基础上给予胰岛素泵治疗,根据血糖调节胰岛素剂量;实验组:在对照组的基础上,加用利拉鲁肽按0.6 mg/d渐递增至1.2 mg/d治疗。3.分别对比两组患者在治疗前及治疗3个月后的空腹血糖(FPG)、餐后2小时血糖(PBG2h)、糖化血红蛋白(HbA1c)、空腹C-肽(CP)、餐后1小时C-肽(1hCP)、空腹胰岛素、餐后1小时胰岛素、β细胞功能指数(HOMA-β)、胰岛素抵抗指数(HOMA-IR)、血脂(TC、TG、HDL、LDL)、血压、体重、体重指数(BMI)、腰臀比(WHR)、同型半胱氨酸(Hcy)、尿微量白蛋白(mAlb)。并且记录两组治疗中低血糖反应次数、胃肠道、肝功能损害等的不良反应;评价分析两组治疗前后胰岛β细胞功能和胰岛素抵抗改善情况。4.统计学分析使用SPSS22.0软件统计包进行相关数据统计学处理,计量资料采用(x__±s)表示,组间比较采用t检验,组间计数资料采用四格表x2检验。检验标准:α=0.05,P0.05为差异有统计学意义。结果:1.两组基线资料的比较,两组入选病例在治疗前从性别、年龄、fpg、pbg2h、hba1c、cp、1hcp、空腹胰岛素、餐后1小时胰岛素、homa-β、homa-ir、tc、tg、hdl、ldl、血压、体重、bmi、whr、hcy、malb、alt、ast、ggt均差异不显著(p0.05)。2.两组治疗前后血糖、糖化血红蛋白的比较:实验组治疗前后的比较fpg(11.97±3.59vs6.29±1.22)、2hbpg(16.34±5.62vs7.36±2.17)、hba1c(11.97±4.59vs5.46±1.67),差异显著(p0.05);对照组治疗前后的比较:fpg(11.29±3.82vs6.97±1.19)、2hbpg(16.86±5.17vs7.34±2.62)、hba1c(12.46±3.67vs5.57±1.59),差异显著(p0.05);实验组与对照组治疗后均可以有效控制fpg、2hpbg、hba1c,差异不显著(p0.05)。3.两组胰岛素、c肽及β细胞功能方面相关参数的比较:实验组治疗前后的比较:cp(1.93±1.13vs3.08±0.98)、1hcp(2.30±1.63vs6.86±1.64)、空腹胰岛素(8.70±0.85vs24.17±2.35)、餐后1小时胰岛素(24.87±2.23vs66.58±2.08)、homa-ir(4.17±1.50vs2.34±1.23)、homa-β(16.57±11.50vs34.76±9.79),差异显著(p0.05)。对照组治疗前后的比较:cp(1.98±0.98vs2.43±1.13)、1hcp(2.86±1.64vs6.30±1.63)、空腹胰岛素(9.15±0.15vs18.20±1.22)、餐后1小时胰岛素(23.95±1.31vs46.55±2.11)、homa-ir(4.20±0.23vs2.77±1.50)、homa-β(16.80±10.97vs23.17±8.43),差异不显著(p0.05);实验组与对照组治疗后,实验组可以有效的改善cp、1hcp、空腹胰岛素、餐后1小时胰岛素、homa-ir、homa-β,降低胰岛素用量,差异显著(p0.05)。3.两组体重、bmi及whr的比较:实验组治疗前后在改善体重、bmi及whr的比较:(83.63±11.22vs76.38±15.33)、(29.20±3.09vs25.01±3.12)(1.03±0.07vs0.85±0.06),差异显著(p0.05);对照组治疗前后在改善体重、bmi及whr的比较:(79.38±15.33vs82.63±10.23)(29.01±3.12vs29.54±3.10)(1.05±0.06vs1.06±0.07),差异不显著(p0.05)。实验组与对照组治疗后比较,实验组可以有效的改善体重、bmi及whr,差异显著(p0.05)。4.两组血脂方面相关参数的比较:实验组治疗前后在改善血脂方面相关参数的比较:tc(5.47±1.42vs4.37±1.39)、tg(4.59±3.09vs3.15±3.46)、hdl(1.15±0.49vs1.87±0.30)、LDL(3.34±1.23vs2.68±1.33)差异显著(P0.05)。对照组治疗前后在改善血脂方面相关参数的比较:TC(5.72±1.39vs5.52±1.43)、TG(4.18±3.46vs 4.15±3.13)、HDL(1.07±0.30vs1.16±0.53)、LDL(3.68±1.33vs1.16±0.53),差异不显著(P0.05)。实验组与对照组治疗后比较,实验组可以有效的降低TC、TG、LDL,增高HDL,差异显著(P0.05)。5.两组收缩压、Hcy、mAlb的比较:实验组治疗前后收缩压、Hcy、mAlb的比较:(134.31±13.12vs130.5±9.67)、(11.97±5.59vs8.46±4.67)、(50.42±8.55vs48.41±8.05),差异显著(P0.05);实验组治疗前后舒张压的比较,(75.31±10.13vs75.24±10.02)差异不显著(P0.05)。对照组治疗前后收缩压、舒张压、Hcy、mAlb的比较:(130.5±9.67vs132.31±12.13)、(75.43±10.52vs75.47±10.13)、(12.46±4.67vs13.57±4.53)、(51.23±8.54vs51.41±8.26),差异不显著(P0.05)。实验组和对照组在治疗后,舒张压均无明显改变,实验组可有效控制收缩压、Hcy、mAlb,差异显著(P0.05)。6.两组不良反应的比较:治疗期间对照组有5例患者发生低血糖反应,发生率为23.81%;实验组有1例患者出现低血糖反应,占总例数4.17%,差异显著(P0.05)。治疗过程中实验组24例患者中有8例患者曾出现过恶心、腹泻症状,占33.33%,有3例不能耐受退出;有4例患者曾出现过便秘症状,占16.67%;有1例患者出现流感样症状(4.17%/24)退出实验组,而对照组未见上述症状,故实验组出现上述不良症状的次数明显高于对照组,差异显著(P0.05)。两组治疗前后ALT、AST、GGT均未见异常改变。结论:1.无论胰岛素泵单用还是利拉鲁肽与胰岛素泵联合应用治疗非初诊2型糖尿病患者均可以平稳控制血糖、降低HbA1c。2.利拉鲁肽与胰岛素泵两药联合应用可以减少胰岛素剂量,明显改善β细胞功能,改善胰岛素抵抗。3.利拉鲁肽与胰岛素泵联合应用可以降低体重、血压、血脂。4.利拉鲁肽与胰岛素泵联合应用比单独应用胰岛素泵更能减少低血糖反应的发生率。
[Abstract]:Objective: To observe the improvement of the treatment of non newly diagnosed type 2 diabetes patients before and after treatment with the combined use of L / L and insulin pump in the control of blood glucose level and weight reduction. To evaluate the clinical effect of the combined effect of two drugs on non newly diagnosed type 2 diabetes patients in order to find a more effective glucose lowering scheme and appropriate clinical dosage for the improvement of the clinical dosage. To provide theoretical and experimental basis for the treatment of non newly diagnosed type 2 diabetic patients and to reduce the adverse drug reactions. Methods: 1. to select 45 non newly diagnosed type 2 diabetic patients who were treated in the Department of Endocrinology, Dongguan branch of Affiliated Hospital of Yan'an University and the Department of endocrinology of the Northern Hospital of the Yulin traditional Chinese medicine hospital, January 2013, all patients with non newly diagnosed type 2 diabetes. The 45 patients were randomly divided into two groups, including 21 cases in the control group and 24 in the experimental group. The control group was treated with insulin pump treatment on the basis of diet exercise, and the insulin dosage was adjusted according to blood glucose; the experimental group was in the 45 cases: the experimental group: in the experimental group: in the experimental group: in the experimental group: in the experimental group: in the experimental group: in the experimental group: in the experimental group: in the experimental group: in the experimental group: in the On the basis of the group, mg/d was added to 1.2 mg/d by 0.6 mg/d to compare the fasting blood glucose (FPG) before and after 3 months of treatment, 2 hours postprandial blood glucose (PBG2h), glycated hemoglobin (HbA1c), fasting C- peptide (CP), 1 hours postprandial C- peptide (1hCP), fasting insulin, 1 hours postprandial insulin, beta cell work Energy index (HOMA- beta), insulin resistance index (HOMA-IR), blood lipid (TC, TG, HDL, LDL), blood pressure, weight, body mass index (BMI), waist to hip ratio (WHR), homocysteine (Hcy), urinary microalbumin (mAlb). And record two groups of adverse reactions in the treatment of hypoglycemia, gastrointestinal tract, liver function damage, and so on and before and after treatment of the two groups of pancreatic islet beta The improvement of cell function and insulin resistance.4. statistical analysis using SPSS22.0 software statistics package for statistical data processing, measurement data using (x__ + s), t test and four lattice x2 test for inter group count data. The test standard: alpha = 0.05, P0.05 for statistical significance. Results: 1. two groups of baseline Comparison of the data, two groups of selected cases from sex, age, age, FPG, pbg2h, HbA1c, CP, 1hcp, fasting insulin, homa- beta, homa- beta, HOMA-IR, TC, TG, HDL, LDL, blood pressure, weight, glucose, glycated hemoglobin, before and after treatment: before and after treatment in the experimental group before treatment After comparison of FPG (11.97 + 3.59vs6.29 + 1.22), 2hbpg (16.34 + 5.62vs7.36 + 2.17), HbA1c (11.97 + 4.59vs5.46 + 1.67), the difference was significant (P0.05); the comparison group before and after treatment: FPG (11.29 + 3.82vs6.97 +), 2hbpg (16.86 + 5.17vs7.34 + 2.62), HbA1c (12.46 + 1.59), significant difference; the experimental group and the control group were all treated after treatment. It could effectively control FPG, 2hpbg, HbA1c, and the comparison of the insulin, C peptide and beta cell function in.3. two groups: the comparison before and after treatment in the experimental group: CP (1.93 + 1.13vs3.08 + 0.98), 1hcp (2.30 + 1.63vs6.86 + 1.64), fasting insulin (8.70 + 0.85vs24.17 + 2.35), and 1 hours after meal insulin (24.87 + 2.23vs66.58 + 2.08) HOMA-IR (4.17 + 1.50vs2.34 + 1.23), homa- beta (16.57 + 11.50vs34.76 + 9.79), significant difference (P0.05). The comparison group before and after treatment: CP (1.98 + 0.98vs2.43 + 1.13), 1hcp (2.86 + 1.64vs6.30 +), fasting insulin (9.15 + 0.15vs18.20 + 1.22), 1 hours after meal (23.95 + 1.31vs46.55 + 2.11), HOMA-IR (4.20 + + + +), HOMA-IR Oma- beta (16.80 + 10.97vs23.17 + 8.43), the difference was not significant (P0.05), the experimental group and the control group after treatment, the experimental group can effectively improve the CP, 1hcp, fasting insulin, 1 hours after meal insulin, HOMA-IR, homa- beta, lower insulin dosage, the difference is significant (P0.05).3. two body weight, BMI and WHR comparison: experimental group before and after treatment to improve body weight, BMI BMI before and after BMI And the comparison of WHR: (83.63 + 11.22vs76.38 + 15.33), (29.20 + 3.09vs25.01 + 3.12) (1.03 + 0.07vs0.85 + 0.06), significant difference (P0.05). The comparison of the weight improvement, BMI and WHR in the control group was (79.38 + 15.33vs82.63 + 10.23) (29.01 + 3.12vs29.54 + 3.10) (29.01 + 3.12vs29.54 + 3.10) (1.05 + 0.06vs1.06 + 0.07), and the difference was not significant (P0.05). The experimental group was treated with the control group. After the treatment, the experimental group could effectively improve the weight, BMI and WHR, and the difference was significant (P0.05).4. two groups of blood lipid related parameters: the experimental group before and after treatment in the improvement of blood lipid related parameters: TC (5.47 + 1.42vs4.37 + 1.39), TG (4.59 + 3.09vs3.15 + 3.46), HDL (1.15 + 0.49vs1.87 + 0.30), LDL (3.34 + 1.23vs2.68 1.33) difference The relative parameters of the control group (P0.05) were compared before and after the treatment in the control group: TC (5.72 + 1.39vs5.52 + 1.43), TG (4.18 + 3.46vs 4.15 + 3.13), HDL (1.07 + 0.30vs1.16 + 0.53), LDL (3.68 + 1.33vs1.16 + 0.53), and no significant difference (P0.05). The experimental group was compared with the control group. DL, the difference of systolic pressure in group.5. two, Hcy, mAlb: the comparison of systolic pressure, Hcy, mAlb in experimental group before and after treatment: (134.31 + 13.12vs130.5 + 9.67), (11.97 + 5.59vs8.46 + 4.67), (50.42 + 8.55vs48.41 + 8.05), significant difference (P0.05), and the difference of diastolic pressure (75.31 + 10.13vs75.24 10.02) before and after treatment (75.31 + 10.13vs75.24 + 10.02) was not significant The comparison of systolic pressure, diastolic pressure, Hcy and mAlb before and after treatment in the control group: (130.5 + 9.67vs132.31 + 12.13), (75.43 + 10.52vs75.47 + 10.13), (12.46 + 4.67vs13.57 4.53), (51.23 + 8.54vs51.41 + 8.26), and no significant difference (P0.05). The diastolic pressure was not significantly changed in the experimental group and the control group, and the experimental group could effectively control the systolic pressure, Hcy, mAl. B, the difference of significant (P0.05).6. two groups of adverse reactions: during the treatment, 5 patients in the control group had hypoglycemia, the incidence of hypoglycemia was 23.81%; in the experimental group, 1 patients had hypoglycemic response, accounting for 4.17% of the total number of cases (P0.05). 8 patients in the 24 patients in the treatment process had had nausea, diarrhea symptoms, and 33.3 in the experimental group. 3%, 3 cases were unwell withdrawn; 4 patients had constipation symptoms, accounting for 16.67%; 1 cases had influenza like symptoms (4.17%/24) withdrawing from the experimental group, while the control group did not have the above symptoms, so the number of adverse symptoms in the experimental group was significantly higher than that of the control group (P0.05). The two groups had no abnormalities of ALT, AST, and GGT before and after treatment. Changes. Conclusions: 1. whether the single use of insulin pump or the combination of the insulin pump and the insulin pump in the treatment of non newly diagnosed type 2 diabetes patients can control the blood glucose smoothly, and the combination of the HbA1c.2. and the insulin pump two drugs can reduce the insulin dose, improve the function of beta cell and improve the insulin resistance.3. Li La Lu peptide. Combined use of the insulin pump can reduce weight, blood pressure, and blood lipid.4., and the combined use of the insulin pump is more likely to reduce the incidence of hypoglycemia than the use of the insulin pump alone.

【学位授予单位】：延安大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R587.1

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