發(fā)布時(shí)間：2018-05-12 22:21

  本文選題：二甲雙胍 + 高胰島素血癥��； 參考：《天津醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探討二甲雙胍結(jié)合生活方式對肥胖高胰島素血癥非糖尿病兒童的臨床效果。方法:回顧性分析2015年1月至2016年12月在天津醫(yī)科大學(xué)總醫(yī)院兒科內(nèi)分泌門診因肥胖就診的兒童82名,其中男孩58例,女孩24例,年齡在8-16歲,平均年齡11.8±1.83歲,均符合肥胖及高胰島素血癥診斷標(biāo)準(zhǔn),其中18例伴糖耐量減低(IGT)。所有兒童均給予調(diào)整飲食結(jié)構(gòu)、增強(qiáng)運(yùn)動(dòng)的生活方式指導(dǎo),同時(shí)口服二甲雙胍片(格華止)0.5g,每日2次到3次,治療1年。治療前及治療3個(gè)月、6個(gè)月、12個(gè)月時(shí)分別測量并計(jì)算各項(xiàng)臨床指標(biāo)[身高、體重、體重指數(shù)(BMI)、腰圍(WC)、臀圍、腰臀比(WHR)、腰圍身高比(WHtR)],治療前及治療6個(gè)月、12個(gè)月時(shí)測定各項(xiàng)生化指標(biāo)[空腹(0小時(shí))及糖負(fù)荷后0.5小時(shí),1小時(shí),2小時(shí),3小時(shí)時(shí)間點(diǎn)血糖、胰島素水平,谷丙轉(zhuǎn)氨酶(ALT)、谷草轉(zhuǎn)氨酶(AST)等],并根據(jù)血糖、胰島素水平計(jì)算胰島功能相關(guān)指標(biāo)(胰島素抵抗指數(shù)、總體胰島素敏感指數(shù)、胰島細(xì)胞功能指數(shù)、早期胰島素分泌指數(shù),胰島素曲線下面積),治療前后進(jìn)行自身對照,使用SPSS18.0軟件,采用自身配對t檢驗(yàn),比較二甲雙胍治療前后各項(xiàng)指標(biāo)的變化,P0.05為結(jié)果有統(tǒng)計(jì)學(xué)差異。治療過程中密切觀測不良反應(yīng),監(jiān)測肝腎功能,及時(shí)調(diào)整用量。結(jié)果:1.口服二甲雙胍1年,BMI由治療前的30.81±4.49kg/m2降低為27.00±4.21kg/m2,治療前后相比,差異具有統(tǒng)計(jì)學(xué)意義(P0.05);治療后WC、WHR與初始相比降低,但3個(gè)月、6個(gè)月、12個(gè)月之間差別無統(tǒng)計(jì)學(xué)意義;與初始相比,WHtR降低,差別有統(tǒng)計(jì)學(xué)意義(P0.05),但6個(gè)月、12個(gè)月之間差別無統(tǒng)計(jì)學(xué)差異。2.口服二甲雙胍治療6個(gè)月時(shí)與治療前相比,各時(shí)間點(diǎn)胰島素水平均有明顯的下降,6個(gè)月與12個(gè)月相比,空腹(0小時(shí))、糖負(fù)荷后1小時(shí)、2小時(shí)胰島素水平繼續(xù)下降,差異有統(tǒng)計(jì)學(xué)意義(均P0.05),0.5h-INS、3h-INS差異無統(tǒng)計(jì)學(xué)意義(P0.05);糖負(fù)荷后2小時(shí)血糖由7.06±1.66mmol/L降低為6.52±1.40mmol/L,差別有統(tǒng)計(jì)學(xué)意義(P0.05)。3.二甲雙胍治療6個(gè)月后,胰島素抵抗指數(shù)、胰島細(xì)胞功能指數(shù)、胰島素曲線下面積下降,總體胰島素敏感指數(shù)升高(均P0.05),二甲雙胍治療12個(gè)月時(shí)胰島素抵抗指數(shù)繼續(xù)降低,總體胰島素敏感指數(shù)繼續(xù)升高(均P0.05),其余指標(biāo)與6個(gè)月時(shí)無統(tǒng)計(jì)學(xué)差異;早期胰島素分泌指數(shù)治療前后無明顯變化;黑棘皮病情況有不同程度的好轉(zhuǎn)。4.二甲雙胍干預(yù)1年后,18例IGT兒童有13例血糖恢復(fù)到正常水平,另外5例有不同程度的降低,糖負(fù)荷后2小時(shí)血糖顯著降低(P0.05);5.二甲雙胍治療后ALT、AST有所降低(P0.05)。6.所有接受二甲雙胍治療的兒童僅有個(gè)別出現(xiàn)腹瀉、腹部不適等胃腸道癥狀,通過調(diào)整可以耐受,均沒有出現(xiàn)皮疹、低血糖、貧血等嚴(yán)重不良反應(yīng)。結(jié)論:1.在調(diào)整飲食結(jié)構(gòu)、加強(qiáng)運(yùn)動(dòng)的基礎(chǔ)上,兒童肥胖高胰島素血癥患者每天服用二甲雙胍1.0克到1.5克,為期1年,可使體重減輕。2.肥胖伴胰島素抵抗兒童,在飲食及運(yùn)動(dòng)指導(dǎo)的基礎(chǔ)上聯(lián)合應(yīng)用二甲雙胍治療1年療效顯著,降低胰島素分泌量,改善胰島素敏感性,減輕胰島素抵抗。3.二甲雙胍可促使IGT患者轉(zhuǎn)為糖耐量正常,延緩糖耐量受損向2型糖尿病發(fā)展,改善肥胖非糖尿病兒童的糖代謝異常。4.鹽酸二甲雙胍減輕體重、改善胰島素敏感性的同時(shí),對改善肝酶有一定的效果。5.二甲雙胍治療肥胖非糖尿病兒童高胰島素血癥較為安全有效,耐受性良好,可有選擇性的應(yīng)用于臨床治療。
[Abstract]:Objective: To investigate the clinical effect of metformin combined with lifestyle on obesity and hyperinsulinemia non diabetic children. Methods: a retrospective analysis of 82 children in the pediatric endocrinology clinic of General Hospital Affiliated to Tianjin Medical University from January 2015 to December 2016 was reviewed. Among them, 58 boys, 24 girls, 8-16 years old, and the average age of 11.8 + 1. .83 years of age were all in accordance with the diagnostic criteria for obesity and hyperinsulinemia in Hefei, of which 18 cases were associated with impaired glucose tolerance (IGT). All children were given a diet structure to improve the lifestyle guidance, and oral metformin tablets (g) 0.5g, 2 to 3 times a day for 1 years. Before and for 3 months, 6 months, 12 months, the patients were measured and measured respectively. The clinical indicators [height, weight, body mass index (BMI), waist circumference (WC), hip circumference, waist to hip ratio (WHR), waist height ratio (WHtR)), preoperative and treatment 6 months, 12 months of biochemical indicators [fasting (0 hours) and sugar load 0.5 hours, 1 hours, 2 hours, 3 hours of blood glucose, insulin levels, ALT, cereal, cereal Aminotransferase (AST), and according to blood glucose and insulin level, calculate the islet function related index (insulin resistance index, total insulin sensitivity index, islet cell function index, early insulin secretion index, area under insulin curve), self control before and after treatment, use SPSS18.0 software, compare two with self matching test, compare two The changes of all indexes before and after treatment with metformin were statistically different in P0.05. During the treatment, the adverse reactions were observed closely, the function of liver and kidney was monitored and the dosage was adjusted in time. Results: 1. oral metformin was taken for 1 years, and the BMI was reduced to 27 + 4.21kg/m2 by 30.81 + 4.49kg/m2 before treatment, and the difference was statistically significant (P0.05) before and after treatment. WC and WHR decreased after treatment, but there was no statistical difference between 3 months, 6 months, and 12 months, and the difference was statistically significant (P0.05) compared with the initial period, but there was no statistical difference between 6 months and 12 months. The level of insulin at each time point was significantly higher than that before the treatment for 6 months after the treatment of oral metformin. The difference was statistically significant (all P0.05), and there was no statistically significant difference between 6 months and 12 months, 1 hours and 2 hours after sugar load (all P0.05), and there was no significant difference in 0.5h-INS and 3h-INS (P0.05), and 2 hours after sugar load decreased from 7.06 + 1.66mmol/L to 6.52 + 1.40mmol/L, and the difference was statistically significant (P0.05).3. two a. After 6 months of metformin treatment, the insulin resistance index, the islet cell function index, the area under the insulin curve decreased, the overall insulin sensitivity index increased (all P0.05). The insulin resistance index continued to decrease with metformin treatment for 12 months, the overall insulin sensitivity index followed Xu Shenggao (P0.05), and the other indexes were not statistically different from that of 6 months. There was no significant change in the early insulin secretion index before and after treatment; black acanthosis was improved in different degrees. After 1 years of.4. metformin intervention, 18 cases of IGT children had 13 cases of blood glucose recovery to normal level, the other 5 had different degrees of decrease, 2 hours after sugar load decreased significantly (P0.05); 5. after metformin treatment, ALT, AST decreased. Children with low (P0.05).6. were treated with metformin only with diarrhea, abdominal discomfort, gastrointestinal symptoms, tolerance, and no serious adverse reactions, such as rash, hypoglycemia, anemia and other adverse reactions. Conclusion: 1. children with obesity and hyperinsulinemia are taken daily on the basis of adjusting the diet structure and strengthening exercise. Metformin, 1 grams to 1.5 grams, lasts 1 years for weight loss of.2. obese children with insulin resistance. On the basis of diet and exercise guidance, combined use of metformin for 1 years is significant, reduces insulin secretion, improves insulin sensitivity, and reduces insulin resistance to.3. dimethyl metformin, which can lead to IGT patients to turn to normal glucose tolerance. To delay the impaired glucose tolerance to the development of type 2 diabetes, improve the glucose metabolism abnormality in obese non diabetic children,.4. hydrochloric acid metformin reduces weight, improves insulin sensitivity, and has a certain effect on improving liver enzymes..5. metformin is safe, effective, and well tolerated in the treatment of obese non diabetic children with hyperisomia. It is selectively applied to clinical treatment.

【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R723.14

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本文編號：1880372