目的 探讨维格列汀联合门冬胰岛素30注射液对肥胖型2型糖尿病患者胰岛β细胞功能及血清糖化血红蛋白(HbA1c)水平的影响。方法 选取西安交通大学第一附属医院2017-03至2018-07肥胖型2型糖尿病患者157例,按照随机数字表法分为对照组(n=78)与联合治疗组(n=79),对照组采取门冬胰岛素30注射液治疗,联合治疗组在对照组基础上联合维格列汀治疗,疗程均为12周。观察对比两组疗效及不良反应发生率,并对两组治疗前后空腹血糖(fasting blood glucose,FPG)、餐后2 h血糖(2 h blood glucose,2 h PG)、糖化血红蛋白(HbA1c)、胰岛β细胞功能指数(HOMA-β)及丝氨酸蛋白酶抑制药(visceral adipose tissue-derived serine protease inhibitor,VASPIN)水平进行比较。结果 联合治疗组HbA1c达标率和控制理想率均明显高于对照组,差异有统计学意义(P<0.05)。两组治疗后FPG、2 h PG、HbA1c水平均比治疗前降低,联合治疗组明显低于对照组,差异有统计学意义(P<0.05)。两组治疗后血清HOMA-β、VASPIN水平均较治疗前升高,联合治疗组较对照组明显升高,差异有统计学意义(P<0.05)。两组不良反应发生率差异无统计学意义。结论 维格列汀联合门冬胰岛素30注射液治疗肥胖型2型糖尿病效果确切,能改善患者的血糖和VASPIN水平,保护胰岛β细胞功能,降低低血糖事件的发生率。
Abstract
Objective To investigate the effect of vildagliptin + insulin aspart 30 injection on islet β-cell function, serum glycosylated hemoglobin (HbA1c) and vaginal adipose tissue-derived serine protease inhibitor (VASPIN) in obese type 2 diabetic patients.Methods A total of 157 patients with obese type 2 diabetes mellitus treated between March 2017 and July 2018 were enrolled in this study. Using the random number table method, these patients were divided into the control group (n=78) and study group (n=79). The control group was injected with insulin aspart 30, while the study group was additionally treated with vildagliptin. The course of treatment was 12 weeks. The curative effect and rate of adverse reactions were compared between the two groups. The fasting blood glucose (FPG), postprandial 2 h blood glucose (2 h PG), HbA1c, islet β cell secretory index (HOMA-β) and VASPIN levels before and after treatment were compared.Results (1) The ideal rate of HbA1c control in the study group was higher than that in the control group (P<0.05). (2) The levels of FPG, 2 h PG and HbA1c in the two groups were lower after treatment, especially in the study group (P<0.05). (3) The levels of serum HOMA-β and VASPIN in the two groups were higher after treatment, particularly in the study group (P<0.05). (4) The total incidence of adverse reactions in the study group was 5.06%, which was not significantly different from the control group (2.56%) (P>0.05).Conclusions The treatment of obese type 2 diabetic patients with vildagliptin + insulin aspart 30 injection is obviously effective, which can improve their blood glucose and serum VASPIN levels, protect islet β cell function, and reduce the incidence of hypoglycemia.
关键词
维格列汀 /
门冬胰岛素30注射液 /
肥胖型2型糖尿病 /
胰岛β细胞功能 /
糖化血红蛋白 /
内脏脂肪组织来源的丝氨酸蛋白酶抑制药
Key words
vildagliptin /
insulin aspart 30 injection /
obese type 2 diabetes /
islet β cell function /
glycated hemoglobin /
visceral adipose tissue-derived serine protease inhibitor
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参考文献
[1] Pan C,Xing X,Han P,et al.Efficacy and tolerability of vild agliptin as add - on therapy to metforminin Chinese patients with type 2diabetes mellitus[J].Diabetes Obes Metab,2012,14(8):737-744.
[2] 陈茂胜,田浩明.二甲双胍联合维格列汀治疗肥胖型2型糖尿病的临床观察[J].现代药物与临床,2014,29(5):503-507.
[3] Derosa G,Maffioli P. Efficacy and safety profile evaluation of acarbose alone and in association with other antidiabetic drugs: asystematic review[J].Clin Ther,2012,34(6):1221-1236.
[4] 赵晓伟,田 坚,沈静雪,等.维格列汀对经二甲双胍治疗的肥胖型2型糖尿病患者肺功能的影响[J].安徽医药,2016,20(2):369-373.
[5] 辛彩虹,李 峥,洛伟光,等.维格列汀联合二甲双胍对超重2型糖尿病患者心血管疾病危险因素的干预作用[J].解放军医药杂志,2015,12(8):83-87.
[6] 徐小华,胡 蕴,苏晓飞,等.维格列汀对磺脲类药物继发性失效的2型糖尿病患者的疗效[J].江苏医药,2016,42(18):1975-1977.
[7] 中华医学会糖尿病学分会.中国2型糖尿病防治指南(2013年版)[J].中国糖尿病杂志,2014,30(8):893-942.
[8] 邓海鸥,林 凯,黎映兰,等.阿卡波糖联合维格列汀治疗老年2型糖尿病患者的效果及安全性[J].广东医学,2015,36(12):1928-1929.
[9] Su J B,Wang X Q,Chen J F,et al.Glycemic variability in insulin treated type 2 diabetes with well-controlled hemoglobin A1c and its response to further treatment with acarbose[J].Chin Med J(Engl),2011,124(1):144-147.
[10] 马淑肖.维格列汀联合二甲双胍与胰岛素强化治疗初诊2型糖尿病患者的对比研究[J].山西医药杂志,2016,45(5):565-567.
[11] Choe E Y,Cho Y,Choi Y,et al.The effect of DPP-4 inhibitors on metabolic parameters in patients with type 2 diabete[J].Diabetes Metab J,2014,38(3):211-219.
[12] 李 睿,王会仓,刘美建.维格列汀联合二甲双胍对新诊断2型糖尿病患者胰岛β细胞功能和胰岛素抵抗的改善作用[J].现代中西医结合杂志,2016,25(23):2575-2577.
[13] 单春艳,孔 岩,殷明亮,等.胰岛素联合维格列汀治疗2型糖尿病合并中度肾损伤患者的有效性和安全性[J].中国糖尿病杂志,2014,6(5):321-324.
[14] 程佳媛,白雪琴,王春光,等.维格列汀对2型糖尿病合并冠心病患者血清脂联素、抵抗素水平的影响[J].现代中西医结合杂志,2015,24(32):3546-3548.
[15] 许 翎,林 凯,邓海鸥,等.维格列汀联合门冬胰岛素治疗老年2型糖尿病患者的疗效及安全性[J].南方医科大学学报,2014,34(10):1515-1518.
[16] Strain W D,Lukashevich V,Kothny W,et al.Individualised treatment targets for elderly patients with type 2 diabetes using vildagliptin add-on or lone therapy(INTERVAL):a 24 week, randomised, doubleblind,placebo-controlled study[J].Lancet,2013,382(9890):409-416.
[17] 彭 莉,马俊花,尤 文,等.维格列汀片对 T2 DM 患者血清尿液淀粉酶水平的影响[J].河北医学,2014,20(5):723-726.
[18] 潘 宇.维格列汀联合门冬胰岛素30注射液治疗老年2型糖尿病的疗效分析[J].中国慢性病预防与控制,2015,23(2):139-140.
[19] 朱鸿玲,王菁楠,尤 文,等.二甲双胍联合维格列汀治疗初诊2型糖尿病的疗效及对血糖波动的影响[J].临床和实验医学杂志,2016,15(11):1078-1081.
[20] 闫赋琴,徐 春.DPP4抑制药对2型糖尿病患者的血糖、血脂、胰岛素、瘦素、SAA和白细胞介素的影响[J].临床和实验医学杂志,2016,15(24):2426-2429.
基金
2018年度陕西省教育厅科学研究计划项目(18JK1123)
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