摘要
目的 探讨磺脲类药物治疗2型糖尿病时发生继发性失效的原因。方法 应用单一磺脲类药物(日最大剂量)1个月后,空腹血糖(FBS)≥10.0 mmol/L或餐后2 h血糖≥13.9 mmol/L者作为磺脲类药物继发性失效组(失效组,43例);应用单一磺脲类药物(服用剂量≤日最大剂量),FBS≤7.0 mmol/L且餐后 2 h血糖≤10.0 mmol/L者作为磺脲类药物有效组(有效组,41例)。测定两组血浆胰岛素、C肽水平的变化,了解B细胞分泌功能。静脉推注正规胰岛素,观察血糖下降的最大速率,估计胰岛素的敏感性。静脉推注胰高糖素,了解 B细胞的储备功能。结果 磺脲类降糖药物刺激后,有效组的血浆胰岛素、C肽水平明显高于失效组;两组胰岛素敏感性大致相同,失效组中大部分(约3/4)病例对胰高糖素刺激仍保持较好的反应性。结论 磺脲类降糖药物治疗2型糖尿病继发性失效的原因主要是B细胞对磺脲类药物反应性降低、分泌功能减退,而对胰岛素敏感性变化不大;失效组中大部分患者的B细胞对胰高糖素仍有较好的反应性。故胰高糖素试验仅可作为判断B细胞储备功能的指标而不宜作为区别磺脲类药物是否有效的指标。
Objective To appraise the cause of secondary failure in type 2 diabetes with sulfonylurea treatment. Methods Measuring the plasma insulin, C peptide level after the glibenclamide stimulation in effective group(41 cases) and failure group(43 cases),made it possible to estimate the β-cell function; the maximum decrement rate of blood sugar in evaluating the sensitivity to insulin and to observe the reserved function of β-cell with glucagon infusion. Results The plasma insulin and C peptide were elevated more obviously in the effective group than those in failure group: insulin sensitivies were almost similar between the two groups. Most cases (about 3/4) in the failure group remained reactive to glucagon stimulation. Conclusion The main cause of secondary failure of sulfonylurea in type 2 diabetes is the diminished reactivity of β-cells to sulfonylurea stimulation but not the change of insulin resistance. Glucagon test can be used for estimating the reserved function of β-cell but not as an indicator of sulfonylurea efficacy.
出处
《上海医学》
CAS
CSCD
北大核心
2005年第2期137-139,共3页
Shanghai Medical Journal
