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【摘要】 目的 分析2型糖尿病患者口服降糖药控制不满意时加用双时相门冬胰岛素30治疗前后血糖水平的变化,探讨其降糖作用。方法 46例2型糖尿病患者口服降糖药控制不满意时,加用双时相门冬胰岛素30治疗6个月,观察其治疗前后血糖水平等的变化。
结果 双时相门冬胰岛素30治疗后空腹血糖(7�7±0�3与 10�9±0�3 mmol/l, P0�05)、高密度脂蛋白胆固醇(51�7±4�1与55�9±3�7 mg/dl, P>0�05)水平治疗前后,未见统计学差异。2型糖尿病患者加用双时相门冬胰岛素30治疗后,糖化血红蛋白0�05) and LDL�C (106�1±10�7 versus 115�8±12�4 mg/dl, P>0�05) levels were not significantly changed after the treatment with BIAsp 30� The percent of subjects reached the target of HbA��1c� 0�05)、高密度脂蛋白胆固醇(HDL�C,51�7±4�1与55�9±3�7 mg/dl,P>0�05)水平治疗前后,未见统计学差异。�
3 讨论�
本研究发现双时相门冬胰岛素30降低2型糖尿病患者FPG、PPG及HbA��1c�水平;同时降低血TG水平。本研究结果与国内外研究报道基本一致��[1�4]�。�
一些药理学研究表明:双时相门冬胰岛素30较双时相人胰岛素吸收快、产生较高的血胰岛素峰值;且控制餐后血糖好,低血糖反应少��[5]�。在细胞模型的研究发现:短效胰岛素类似物与胰岛素的生物学作用相似;但长效胰岛素类似物在细胞分裂信号传导上的作用强于胰岛素,导致细胞增殖��[6]�。糖尿病治疗的主要目的是控制血糖、减少并发症的危险。口服降糖药作为单一药物治疗,疗效短暂;三年内50%糖尿病患者HbA��1c�不能维持在7�0%以下��[5]�。因此,积极的胰岛素治疗,有助于糖尿病患者的血糖控制。根据血糖控制情况,双时相门冬胰岛素30可以从每日一次加至三次��[7]�;尤其适用于HbA��1c�9�0%以上者��[1]�。该药可有效控制绝大多数2型糖尿病患者血糖水平��[7]�;亦可用于老年患者,但应注意个体化问题��[8]�。�
血TG水平升高是2型糖尿病患者常见的血脂代谢紊乱。Hayashi等报道:胰岛素强化治疗降低血TG、小密LDL�C、富含TG的载脂蛋白水平��[4]�。致动脉粥样硬化性小密LDL�C的降低,可能与胰岛素强化治疗降低富含TG的载脂蛋白中TG水平有关��[4]�。胰岛素对于血脂代谢的作用,可能优于促进胰岛素释放的口服降糖药瑞格列奈(repaglinide)��[9]�。但目前胰岛素对于血脂代谢作用的资料不多,仍有待进一步深入研究。�
根据多个国家的支出有效性分析:双时相门冬胰岛素30优于甘精胰岛素和双时相人胰岛素;特定条件下可能是首选药物��[10]�;说明该药经济有效,有良好的临床应用前景。�
总之,双时相门冬胰岛素30改善口服降糖药控制不满意的2型糖尿病患者的血糖控制及血脂代谢,可能有助于降低2型糖尿病患者并发症,改善预后。�
参 考 文 献�
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