应用胰岛素治疗的2型糖尿病患者血清胰岛素水平升高的影响因素

发布时间：2018-05-04 06:26

本文选题：2型糖尿病 + 胰岛素水平　；参考：《华北理工大学》2017年硕士论文

【摘要】：目的研究应用胰岛素治疗的2型糖尿病患者血清胰岛素水平升高的影响因素,为2型糖尿病患者提供更加合理化、规范化及个体化的治疗。方法选取我院(华北理工大学附属医院)内分泌科住院的应用胰岛素皮下注射降血糖治疗的2型糖尿病(T2DM)患者231例,其中男性患者113例,女性患者118例,年龄范围为24~82岁,平均年龄为(57.62±10.50)岁。根据血清胰岛素水平分为T2DM合并血清胰岛素水平升高组(病例组)36例,其中男性13例,女性23例,年龄范围为39~75岁,平均年龄(58.75±8.70)岁;血清胰岛素水平分为T2DM合并血清胰岛素水平升高组(病例组)共195例,应用SPSS选择个案选项随机选择108例,作为1:3对照,其中男58例、女50例,年龄在26-80岁,平均年龄(56.70±10.97)岁。入组患者均测定空腹血清胰岛素水平(FIns)及餐后2小时血清胰岛素水平(2h Ins),并比较两组间性别、年龄、身高、体重、体重指数(BMI)、吸烟及饮酒情况、入院前空腹血糖平均值、入院前胰岛素应用剂量、应用胰岛素时间、出院胰岛素用量、糖尿病病程、饮食及运动情况、血尿酸(UA)、糖化血红蛋白(Hb A1c)、空腹血糖(FPG)、甘油三酯(TG)、低密度脂蛋白(LDL-C)、空腹血糖(FPG)、餐后2h血糖(2h PG)、空腹C肽(FC-P)、餐后2h C肽(2h C-P)、胰岛素抵抗指数(HOMA-IR)、糖尿病合并症、高血压等指标。数据采用SPSS 21分析,正态分布计量资料以均数±标准差((?)±s)表示,两组间比较采用独立样本t检验;计数资料以百分率表示,采用卡方检验;T2DM患者高血清胰岛素水平的危险因素采用非条件二分类logistic回归模型分析;以P0.05为差异有统计学意义。结果两组间性别构成、是否糖尿病饮食或运动构成比、吸烟饮酒史构成比及有无糖尿病并发症构成比经卡方检验显示,两组间性别构成比、吸烟饮酒史构成比差异无统计学意义(P0.05),两组间是否进行糖尿病饮食或运动控制构成比及并发症构成比差异有统计学意义(P0.05),其中血清胰岛素水平升高组、饮食运动占比较低,合并症占比较高。两组间入院胰岛素用量、TG、UA、FIns、2h Ins、C-P、2h C-P、HOMA-IR经t检验显示,血清胰岛素水平升高组上述指标均高于血清胰岛素水平正常组,差异有统计学意义(P0.05);将卡方检验及t检验有统计学差异的指标作为自变量,以是否出现血清胰岛素水平升高为因变量进行非条件二分类logistic回归模型分析,在校正是否进行糖尿病饮食或运动、入院胰岛素用量、TG、BMI、UA、C-P、2h C-P、HOMA-IR糖尿病合并症等因素的影响结果显示甘油三酯(OR=2.34)、HOMA-IR(OR=1.21)、2h C-P(OR=1.92)是T2DM合并高胰岛素水平的危险因素,糖尿病饮食或运动是保护因素(OR=0.19)。结论糖尿病饮食或运动控制欠佳的患者胰岛素水平上升的危险性升高。甘油三酯升高是应用胰岛素的糖尿病患者胰岛素水平升高的影响因素。
[Abstract]:Objective to study the influencing factors of serum insulin level in patients with type 2 diabetes treated with insulin, and to provide more rational, standardized and individualized treatment for type 2 diabetes. Methods 231 patients with type 2 diabetes mellitus (T2DM) treated by hypoglycemic insulin subcutaneous injection were selected from Endocrine Department of North China University of Technology (affiliated Hospital of North China University of Science and Technology). 113 cases were male and 118 cases were female. The age range was 24 ~ 82 years old. The average age was 57.62 卤10.50 years old. According to the serum insulin level, 36 cases of T2DM with elevated serum insulin level were divided into three groups, including 13 males and 23 females. The age range was 3975 years (mean 58.75 卤8.70) years. The serum insulin level was divided into two groups: T2DM with elevated serum insulin level (n = 195). 108 cases were randomly selected by SPSS selection as a control group at 1:3, including 58 males and 50 females, aged from 26 to 80 years, with an average age of 56.70 卤10.97 years. Fasting serum insulin levels (FIns) and 2 hours postprandial serum insulin levels were measured. Sex, age, height, body mass index (BMI), smoking and drinking, fasting blood glucose before admission were compared between the two groups. The dosage of insulin before admission, the time of insulin use, the amount of insulin discharged from hospital, the course of diabetes, diet and exercise, Serum uric acid (UAA), glycosylated hemoglobin (HbA1cN), fasting blood glucose (FPGN), triglyceride (TGN), low density lipoprotein (LDL-C), fasting plasma glucose (FPG), 2 h postprandial glucose (2 h), 2 h postprandial C-peptide (FC-PN), 2 h postprandial C-peptide (FC-PN), insulin resistance index (HOMA-IRN), diabetes mellitus (DM), hypertension and so on. The data were analyzed by SPSS 21, the normal distribution measurement data were expressed as mean 卤standard deviation) 卤s, and the two groups were compared by independent sample t test, and the counting data were expressed as percentage. The risk factors of high serum insulin level in patients with T2DM were analyzed by non conditional two classification logistic regression model. Results the sex composition of the two groups, whether diabetes diet or exercise composition ratio, smoking and drinking history ratio and diabetes complications composition ratio by chi-square test showed that the sex composition ratio between the two groups. There was no significant difference in the proportion of smoking and drinking history between the two groups (P 0.05). There was a significant difference in the proportion of diabetic diet or exercise control between the two groups and the ratio of complications. In the group with elevated serum insulin level, the proportion of diet and exercise was lower than that of the control group. Complications are relatively high. The dosage of insulin on admission between the two groups was higher than that in the group with normal serum insulin level, and the results of t test showed that the serum insulin level was higher in the patients with elevated serum insulin level than in the group with normal serum insulin level for 2 h, and the serum insulin level was higher than that in the group with normal serum insulin level for 2 hours. The difference was statistically significant (P 0.05). The independent variables of chi-square test and t test were taken as independent variables, and the non-conditional two-class logistic regression model was used to analyze whether the serum insulin level increased as dependent variable. After adjusting whether to take diabetes diet or exercise, the effect of TGG BMIUAUAUAUAA 2 h C-PHOMA-IR diabetes complication and other factors showed that HOMA-IRO 1.21 h 2 h C-PHOO 1.92) was the risk factor of T2DM with high insulin level, and diabetic diet or exercise was the protective factor. Conclusion Diabetic patients with poor diet or exercise control increased the risk of insulin levels. Elevated triglyceride levels are associated with insulin levels in diabetic patients treated with insulin.
【学位授予单位】：华北理工大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.1

【参考文献】