目的 探讨短程胰岛素泵治疗对初诊超重老年2型糖尿病β细胞功能的影响及其改善机制。方法 112例初诊超重老年2型糖尿病患者,随机分成胰岛素泵强化治疗(CSII)组和口服药物治疗(OHA)组,测定两组治疗前后空腹胰岛素(胰岛素原、免疫原性胰岛素)、血清炎性反应因子[超敏C反应蛋白(hsCRP)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)],以及空腹胰岛素原(PI)、空腹免疫原性胰岛素(IRI)、超敏C反应蛋白(hsCRP)等,计算胰岛素分泌指数(HOMA B)及胰岛素抵抗指数(HOMA-IR)。结果 两组治疗前后HOMA B、HOMA-IR均有明显改善(P＜0.05),但CSII组PI/IRI(7.5±1.4 vs 3.8±1.6)、炎性因子[ΔhsCRP: (0.9±0.4)vs (0.3±0.1) mg/L、ΔTNF-α:(1.1±0.4) vs (0.4±0.3) ng/L]有更显著的下降(P＜0.05);多元回归分析提示PI/IRI下降与hsCRP、TNF-α、IL-6下降呈正相关(P＜0.05)。结论 短程胰岛素泵治疗可以改善初诊超重老年2型糖尿病胰岛β细胞功能,且可能与改善炎性反应有关。

Objective To investigate the mechanism of effect of short term intensive insulin therapy on βcell functions with newly diagnosed elderly overweight type 2 diabetesmellitus. Methods 112 patients were divided into two groups. 60 patients received therapy of continuous subcutaneous insulin infusion(CSII). 52 patients accepted therapy of oral hypoglycaemic agents(OHA).All patients were tested plasma proinsulin(PI),immunoreactive insulin(IRI),high sensitivity C-reactive protein(hsCRP), tumor necrosis factor-α(TNF-α), interleukin-6 (IL-6)before therapy and after therapy; homoeostasis model assessment basal β-cell function (HOMA B) and insulin resistance (HOMA-IR)were calculated. Results After therapy, HOMA B and HOMA-IR were significantly increased in two groups, compared with before therapy(P＜0.05). PI/IRI(ΔPI/IRI:7.5±1.4 vs 3.8±1.6) and inflammatory fator[ΔhsCRP: 0.9±0.4 vs 0.3±0.1(mg/L)、ΔTNF-α:1.1±0.4 vs 0.4±0.3(ng/L)、ΔIL-6:0.7±0.3 vs 0.4±0.2(ng/L)] were significantly decreased in CSII group after therapy(P＜0.05). Multiple linear regression analysis showed that the decrease in PI/IRI was positively correlated with the decrease in hsCRP,TNF-α and IL-6(P＜0.05). Conclusions The effect of short term intensive insulin therapy on βcell function with newly diagnosed elderly overweight type 2 diabetesmellitus is related to inflammation.