小剂量螺内酯联合盐酸吡格列酮片治疗绝经期糖耐量低减患者的效果

发布时间：2018-08-15 18:40

【摘要】：目的绝经期糖耐量低减(IGT)患者给予小剂量螺内酯联合盐酸吡格列酮片治疗,对比患者血糖、胰岛素抵抗指数、血脂、血压、体质指数(BMI)及不良反应的变化。方法前瞻性研究经葡萄糖耐量实验明确诊断的自然绝经并IGT患者127例,根据随机数字表法分为3组,分别给予盐酸吡格列酮片15 mg/d单药治疗(A组,n=43)、盐酸吡格列酮片联合螺内酯20 mg/d治疗(A+S20组,n=42)及盐酸吡格列酮片联合螺内酯40 mg/d治疗(A+S40组,n=42),分别用药24周后,分析患者空腹血糖(FPG)、餐后2 h血糖(2h PG)、糖化血红蛋白(Hb A1C)、空腹胰岛素(FIns)、餐后2 h胰岛素(2h Ins)、胰岛素抵抗指数(HOMA-IR)、三酰甘油(TG)、总胆固醇(TC)、血压、BMI和其他不良反应。采用数值变量单因素双水平配对资料t检验、数值变量单因素三水平方差分析和分类变量独立样本R×C列联表醊2检验。结果 (1)3组组内用药前后:2h PG、Hb A1C、FIns、2h Ins、HOMA-IR较前下降(P0.05),A组舒张压(DBP)、TC下降,BMI增加(P0.05),A+S20组、A+S40组TC、TG、收缩压(SBP)、DBP下降(P0.05)。(2)3组用药后各组间对比:A+S20组与A组相比,FIns、HOMA-IR、TC、SBP、DBP、BMI下降(P0.05);A+S40组与A组相比,2h PG、Hb A1C、FIns、HOMA-IR、TC、SBP、DBP、BMI下降(P0.05);A+S40组与A+S20组相比,FIns、HOMA-IR、DBP下降(P0.05)。结论盐酸吡格列酮片治疗IGT患者,可有效改善患者血糖、HOMA-IR、血脂、血压等水平,联合小剂量利尿剂后HOMA-IR、血压改善更加明显,体重增加及水肿等不良反应相应减少,且未增加电解质紊乱的风险。
[Abstract]:Objective to compare the changes of blood glucose, insulin resistance index, blood lipid, blood pressure, body mass index (BMI) and adverse reactions in patients with impaired glucose tolerance (IGT) treated with small dose of spironolactone combined with pioglitazone hydrochloride. Methods A prospective study was conducted on 127 patients with natural menopause and IGT diagnosed by glucose tolerance test. They were treated with pioglitazone hydrochloride for 15 mg/d (group A), pioglitazone hydrochloride combined with spironolactone for 20 mg/d (group A S20) and pioglitazone hydrochloride combined with spironolactone 40 mg/d (group A S40) for 24 weeks. Fasting blood glucose (FBG) 2 h postprandial blood glucose (HbA1C), fasting insulin (FIns), 2 h postprandial insulin (2 h Ins), insulin resistance index (HOMA-IR), triglyceride (TG), total cholesterol (TC), blood pressure and other adverse reactions) were analyzed. T test of single factor and double level matched data of numerical variable, analysis of three levels of variance of single factor of numerical variable and independent sample of classified variable R 脳 C linked table / 2 test were used. Results (1) before and after treatment, the HOMA-IR of HbHbA1C / FINS 2 h decreased in group A (P0.05). The decrease of (DBP) and TC in group A were increased (P0.05). The decrease of (SBP) in group A (P0.05), the decrease of (SBP) in group A (P05), and the decrease in BMI of group A (P 0.05) in group A and group A (P < 0.05) after treatment, the decrease of (DBP) in group A and group A was compared with that in group A (P0.05). (P0.05) in group A and group A, there was a decrease in BMI of (SBP) in group A and group A (P < 0.05), and the difference between group A and group A (P < 0.05) in comparison between group A and group A (P < 0.05) in comparison with group A, group A and group A (P < 0.05). Compared with the control group, the BMI of HbA1CU FInsOHMA-IRN TCU SBPnDBP decreased (P0.05), and that of AS-40 group was significantly lower than that of AS20 group (P0.05), and the level of FInsHoma -IRN DBP was significantly lower than that of A20 group (P0.05). Conclusion pioglitazone hydrochloride can effectively improve the levels of HOMA-IRL, blood lipid and blood pressure in patients with IGT. The improvement of blood pressure is more obvious in combination with low-dose diuretic, and the adverse reactions such as weight gain and edema decrease correspondingly. And did not increase the risk of electrolyte disorders.
【作者单位】：天津市第一中心医院内分泌科;
【分类号】：R587.1

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