利拉鲁肽联合甘精胰岛素对新诊断2型糖尿病疗效的观察

发布时间：2019-03-27 19:35

【摘要】：研究背景随着经济的高速发展、生活水平的提高、生活方式的改变、人口的老龄化,2型糖尿病(type2diabetesmellitus,T2DM)发病率迅速增长,成为严重危害人类健康最重要的慢性非传染性疾病之一[1]。根据2015年国际糖尿病联盟(IDF)公布的第七版“IDF糖尿病地图”显示,在全球范围内,20～79岁成人中约有8.8%的人患有糖尿病,这意味着全球约有4.15亿糖尿病患者;中国糖尿病患者数达1.096亿,居全球首位,其中2型糖尿病患者占糖尿病患者总数的90%以上。从上述调查数据看,我国的糖尿病现状十分严峻,中国已成为全球范围内糖尿病患者增长最快的国家,并且已经超过印度成为世界糖尿病第一大国[2]。不断增加的糖尿病患者人数一方面对人类健康带来极大的危害,另一方面也对社会经济的发展带来巨大的医疗负担。因此,糖尿病已成为全世界各国重大公共卫生问题,而且糖尿病的防治重点应该放在2型糖尿病上。由于胰岛β细胞功能障碍,2型糖尿病患者的胰岛素分泌不足而致血糖升高。因此,针对2型糖尿病患者的治疗,早期干预以改善β细胞功能就显得非常重要。对于新诊断2型糖尿病患者,早期实施短期的胰岛素强化治疗,不仅能够快速清除葡萄糖毒性,使得胰岛β细胞的功能得到部分恢复;而且部分新诊断的2型糖尿病患者在一段时间内有可能无需依赖降糖药且能维持血糖达标。目的本论文旨在探讨应用利拉鲁肽联合甘精胰岛素治疗新诊断2型糖尿病患者的疗效。方法选取我院内分泌科自2014年8月至2015年12月新诊断2型糖尿病患者61例,按照随机数字表法分为两组,观察组(29例)给予利拉鲁肽联合甘精胰岛素治疗,对照组(32例)给予胰岛素强化治疗,分析比较两组治疗前后的疗效。结果随访12周,全部患者的血糖和胰岛素抵抗指数(空腹血糖FPG、餐后2h血糖2hPG、糖化血红蛋白HbA1c、HOMA-IR)、血脂指标和体质量指标在治疗随访期间均有所下降,而HOMA-β,高密度脂蛋白-胆固醇HDL-C均有所上升,两种治疗方法均安全有效。然而,观察组起效较快,在治疗4周后,上述各项指标较治疗前均明显改善,而对照组需治疗12周后,上述指标与治疗前相比才有统计学差异。同时,观察组在治疗4和12周后,上述指标均显著优于对照组,差异具有显著性(P0.05)。结论治疗随访12周,利拉鲁肽联合甘精胰岛素降糖、调脂、降体质量和胰岛功能恢复效果都显著优于胰岛素强化治疗,值得临床推广应用。
[Abstract]:Background with the rapid development of economy, the improvement of living standard, the change of life style, the aging of population and the rapid increase of the incidence of type 2 diabetes mellitus (type2diabetesmellitus,T2DM), It has become one of the most important chronic non-communicable diseases that seriously endanger human health [1]. According to the seventh edition of the IDF Diabetes Map published by the International Diabetes Alliance (IDF) in 2015, about 8.8 percent of adults aged 20 to 79 worldwide have diabetes, meaning that there are about 415 million diabetics around the world. China has 109.6 million diabetes patients, ranking first in the world, in which type 2 diabetes patients account for more than 90% of the total number of diabetes patients. According to the above-mentioned survey data, the present situation of diabetes in China is very serious. China has become the fastest-growing country in the world, and has overtaken India to become the world's largest diabetes mellitus country [2]. On the one hand, the increasing number of diabetes patients brings great harm to human health, on the other hand, it also brings huge medical burden to the development of social economy. Therefore, diabetes has become a major public health problem all over the world, and the prevention and treatment of diabetes should be focused on type 2 diabetes. Due to islet 尾-cell dysfunction, insulin secretion deficiency in type 2 diabetic patients leads to elevated blood glucose. Therefore, for the treatment of type 2 diabetes, early intervention to improve 尾-cell function is very important. For newly diagnosed patients with type 2 diabetes mellitus, short-term intensive insulin therapy can not only clear the glucose toxicity quickly, but also partially restore the function of islet 尾 cells. And some newly diagnosed patients with type 2 diabetes may not need to rely on hypoglycemic drugs for some time and keep their blood sugar up to standard. Objective to investigate the efficacy of lirapeptide combined with insulin in the treatment of newly diagnosed type 2 diabetes mellitus. Methods from August 2014 to December 2015, 61 newly diagnosed patients with type 2 diabetes mellitus were randomly divided into two groups: the observation group (n = 29) was treated with Lilalupin combined with insulin, and the patients in the observation group (n = 29) were divided into two groups according to the method of random number table. The control group (32 cases) were treated with insulin intensive therapy, and the curative effects before and after treatment were analyzed and compared between the two groups. Results after 12 weeks of follow-up, blood glucose and insulin resistance index (fasting blood glucose, 2 h postprandial blood glucose, 2 h PGG, glycosylated hemoglobin HbA1c,HOMA-IR), blood lipid and body mass index decreased, but HOMA- 尾, decreased in all patients after 12-week follow-up. High-density lipoprotein-cholesterol (HDL-C) HDL-C increased, and both treatments were safe and effective. However, the effect of the observation group was faster. After 4 weeks of treatment, all the above indexes were obviously improved compared with the pre-treatment, while the control group needed 12 weeks of treatment, the above-mentioned indexes had statistical difference compared with the pre-treatment. At the same time, 4 and 12 weeks after treatment, the above indexes in the observation group were significantly better than those in the control group, the difference was significant (P0.05). Conclusion after 12 weeks of follow-up, lirapeptide combined with insulin can reduce glucose, regulate lipid, decrease body mass and restore islet function significantly better than that of intensive insulin therapy. It is worth popularizing and applying in clinical practice. [WT5 "HZ] conclusion [WT5" BZ]
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.1

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