摘要
背景在成年人中有1/12的患者死亡可归因于糖尿病。糖尿病患者血脂、炎性因子明显高于非糖尿病患者。且高血脂、高血糖、高炎性因子水平往往增加心血管疾病风险。目的探讨艾塞那肽联合胰岛素治疗血糖控制不佳的2型糖尿病患者对纤维蛋白原(FIB)、超敏C反应蛋白(hs-CRP)、白介素6(IL-6)及肿瘤坏死因子α(TNF-α)的影响。方法选取2016年6月-2018年6月在徐州医科大学附属医院内分泌科住院或门诊治疗的2型糖尿病患者193例为研究对象。将研究对象随机分为艾塞那肽组(n=98)和胰岛素组(n=95)。所有患者继续以往的饮食、运动及口服药物。艾塞那肽组加用艾塞那肽同时胰岛素剂量暂减30%,以后根据血糖水平调节胰岛素剂量。胰岛素组根据血糖水平单纯调节胰岛素剂量。治疗6个月后比较两组降糖效果及FIB、hs-CRP、IL-6、TNF-α的变化。同时采用多元逐步线性回归分析炎性标志物的影响因素。结果两组治疗后空腹血糖(FPG)、餐后2 h血糖(2 hPG)、胰岛素抵抗指数(HOMA-IR)、糖化血红蛋白(HbA1c)、三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、hs-CRP、IL-6及TNF-α均较治疗前降低,差异有统计学意义(P<0.05);治疗后艾塞那肽组HOMA-IR、hs-CRP、IL-6及TNF-α低于胰岛素组,差异有统计学意义(P<0.05)。艾塞那肽组治疗后体质量、体质指数(BMI)、腰围(WC)及胰岛素日用量较治疗前降低,差异有统计学意义(P<0.05);FIB治疗后与治疗前比较,差异无统计学意义(P>0.05)。胰岛素组治疗后体质量、BMI、WC及胰岛素日用量较治疗前增高,差异有统计学意义(P<0.05);FIB与治疗前比较,差异无统计学意义(P>0.05)。无论是在艾塞那肽组,还是在胰岛素组,△FIB与△WC、△体质量、△BMI、△HOMA-IR呈正相关(r=0.269~0.423,P<0.05),△hs-CRP与△WC及△HOMA-IR呈正相关(r=0.223~0.515,P<0.05),△IL-6和△TNF-α与△WC呈正相关(r=0.215~0.379
Background One in twelve deaths in adults can be attributed to diabetes.Diabetic patients have significantly increased blood lipid and inflammatory markers.Moreover,hyperlipidemia,hyperglycemia and elevated inflammatory markers often increase the risk of cardiovascular disease.Objective To investigate the effect of exenatide combined with insulin on fibrinogen(FIB),high-sensitivity C-reactive protein(hs-CRP),interleukin-6(IL-6) and tumor necrosis factor alpha(TNF-α) in patients with type 2 diabetes with poor glycemic control.Methods A total of 193 outpatients and inpatients with T2 DM were recruited from Department of Endocrinology,Affiliated Hospital of Xuzhou Medical University from June 2016 to June 2018,and were randomized into exenatide group(n=98) and insulin group(n=95).All patients continued their previous diet,exercise,and oral medication.Besides,the exenatide group additionally took exenatide,and the insulin dose was temporarily reduced by 30%,then was adjusted according to blood glucose later.The insulin group only adjusted the insulin dose based on the blood glucose level.After 6 months of treatment,hypoglycemic effects and changes of FIB,hs-CRP,IL-6 and TNF-α were compared between the two groups.Multiple stepwise linear regression analysis was used to analyze the influencing factors of inflammatory markers.Results FPG,2 h PG,HOMA-IR,Hb A1 c,TG,TC,LDL-C,hs-CRP,IL-6 and TNF-α were all decreased in both groups after treatment(P<0.05),whereas HOMA-IR,hs-CRP,IL-6 and TNF-α in exenatide group were significantly lower than those in the insulin group(P<0.05).In the exenatide group,mean body weight,body mass index(BMI),waist circumference(WC) and daily insulin dosage were also decreased as compared with baseline(P<0.05),but the difference of FIB was not significant compared with the pre-treatment(P>0.05).In the insulin group,mean body weight,BMI,WC and daily insulin dosage were increased as compared with baseline(P<0.05),but the difference of FIB was not significant(P>0.05).The difference of pre-and post-
作者
赵倩
应长江
凌宏威
李树法
张婷
王佳鑫
李伟
ZHAO Qian;YING Changjiang;LING Hongwei;LI Shufa;ZHANG Ting;WANG Jiaxin;LI Wei(Department of Endocrinology,the Affiliated Hospital of Xuzhou Medical University,Xuzhou 221006,China;School of Clinical Medicine,Xuzhou Medical University,Xuzhou 221000,China;Department of Endocrinology,the Third People's Hospital of Linyi,Linyi 276023,China)
出处
《中国全科医学》
CAS
北大核心
2020年第13期1666-1671,共6页
Chinese General Practice
基金
国家自然科学基金资助项目(81570694)。
