本文選題：單純性肥胖 + 胰島素抵抗��； 參考：《大連醫(yī)科大學(xué)》2017年碩士論文

【摘要】：背景隨著全球經(jīng)濟(jì)化的發(fā)展,肥胖癥已經(jīng)成為嚴(yán)重的公共衛(wèi)生問題,兒童肥胖癥發(fā)病率逐年上升,采取有效措施控制肥胖刻不容緩。目前肥胖的治療方案主要包含調(diào)整膳食結(jié)構(gòu)、體育鍛煉、藥物治療、認(rèn)知治療和手術(shù)治療,而藥物治療是重要環(huán)節(jié)。二甲雙胍可以用于治療兒童糖尿病,它除降糖外有控制體重的作用。目的本課題主要探討二甲雙胍是否可以降低肥胖兒童的體重及體重指數(shù)(BMI),改善胰島素抵抗及糖脂代謝紊亂。并觀察1例單獨應(yīng)用二甲雙胍治療兒童2型糖尿病(T2DM)的療效。材料及方法本課題主要收集2010年6月到2016年10月于大連醫(yī)科大學(xué)附屬第二醫(yī)院兒科病房住院的9-14周歲,診斷為單純性肥胖及胰島素抵抗的全部兒童作為治療組,共41例,口服二甲雙胍治療12周,監(jiān)測治療前后的體重、身高、BMI、空腹血糖、空腹胰島素、C肽、糖化血紅蛋白、胰島素抵抗指數(shù)(HOMA-IR)、甘油三酯、低密度脂蛋白、高密度脂蛋白、總膽固醇等指標(biāo)變化。另外選擇同時期于大連醫(yī)科大學(xué)附屬第二醫(yī)院兒科門診常規(guī)體檢的9-14周歲正常身高體重的兒童20例作為對照組,比較該組兒童與治療組兒童用藥前BMI、空腹血糖、空腹胰島素、HOMA-IR值的差別。統(tǒng)計學(xué)上,對于計量資料,符合正態(tài)分布的資料以均值±標(biāo)準(zhǔn)差((?)±S)表示,采用t檢驗比較,不符合正態(tài)分布的資料以中位數(shù)(P25 P75)表示,采用非參數(shù)檢驗比較。計數(shù)資料采用卡方檢驗進(jìn)行比較。各自計算其P值,P0.05提示差異有統(tǒng)計學(xué)意義。同時報道1例大連醫(yī)科大學(xué)附屬第二醫(yī)院兒科住院的診斷為T2DM及單純性肥胖的女童,年齡為10.58歲,單獨口服二甲雙胍治療,動態(tài)監(jiān)測空腹血糖、糖化血紅蛋白、HOMA-IR等指標(biāo)8個月。結(jié)果1.治療組兒童與對照組兒童的平均年齡、性別構(gòu)成及空腹血糖的差異無統(tǒng)計學(xué)意義(P0.05)。治療組兒童用藥前BMI、空腹胰島素及Ln(HOMA-IR)顯著高于對照組,差異有統(tǒng)計學(xué)意義(P0.001)。2.治療組兒童予以口服二甲雙胍治療l2周后,體重由用藥前的(74.66±15.02)kg降到用藥后的(71.91±14.19)kg,差異有統(tǒng)計學(xué)意義(P=0.004),BMI由治療前的(29.36±4.42)kg/m~2降到治療后的(27.40±3.99)kg/m~2,差異有統(tǒng)計學(xué)意義(P0.001),身高較前增長,差異有統(tǒng)計學(xué)意義(P=0.002)。3.治療組兒童予以口服二甲雙胍治療l2周后,空腹血糖較前下降,差異有統(tǒng)計學(xué)意義(P=0.002),Ln(HOMA-IR)、空腹胰島素、C肽、糖化血紅蛋白均明顯下降,差異有統(tǒng)計學(xué)意義(P0.001)。4.治療組兒童予以口服二甲雙胍12周后27名(65.85%)兒童HOMA-IR值降到3.5以下,其中24名(58.54%)兒童的HOMA-IR值降到3.16以下。5.治療組兒童予以口服二甲雙胍l2周后,甘油三酯較前下降,差異有統(tǒng)計學(xué)意義(P=0.002),低密度脂蛋白、總膽固醇明顯下降,差異有統(tǒng)計學(xué)意義(P0.001),而高密度脂蛋白的前后變化無統(tǒng)計學(xué)意義(P=0.635)。6.報道1例診斷為2型糖尿病及單純性肥胖女童,單獨應(yīng)用二甲雙胍治療,動態(tài)監(jiān)測其空腹血糖于3天后降至正常,糖化血紅蛋白于2月后降至正常,HOMA-IR亦呈明顯下降趨勢。7.用藥兒童口服二甲雙胍過程中4例(9.52%)出現(xiàn)不良反應(yīng),均為消化道反應(yīng),腹瀉1例,惡心、腹脹3例,發(fā)生在用藥前2周,未予處置,自行恢復(fù)正常。結(jié)論1.二甲雙胍能夠降低單純性肥胖兒童的體重及BMI。2.二甲雙胍能夠調(diào)節(jié)單純性肥胖兒童的糖代謝紊亂,改善胰島素抵抗。3.二甲雙胍能夠降低單純性肥胖兒童的甘油三酯、低密度脂蛋白及總膽固醇。4.二甲雙胍能夠治療青少年T2DM。
[Abstract]:Background with the development of global economy, obesity has become a serious public health problem. The incidence of obesity in children is increasing year by year. It is urgent to take effective measures to control obesity. At present, the treatment scheme of obesity mainly includes adjustment of dietary structure, physical exercise, drug treatment, cognitive therapy and surgical treatment, and drug treatment is heavy. Metformin, which can be used to treat children with diabetes, has the effect of controlling weight in addition to hypoglycemic control. The subject is to investigate whether metformin can reduce the weight and body mass index (BMI) of obese children, improve insulin resistance and metabolic disorder of glucose and lipid, and observe 1 cases of children with type 2 diabetes treated by metformin alone. The effect of disease (T2DM). Materials and methods mainly collected from June 2010 to October 2016 in the second hospital of the Second Affiliated Hospital of Dalian Medical University, 9-14 years of hospitalization in the pediatric ward, diagnosed as simple obesity and insulin resistance in all children as the treatment group, a total of 41 cases, oral two a guanidine treatment for 12 weeks, monitoring the weight, height, before and after treatment. BMI, fasting blood glucose, fasting insulin, C peptide, glycosylated hemoglobin, insulin resistance index (HOMA-IR), triglyceride, low density lipoprotein, high density lipoprotein, total cholesterol, etc., 20 children with normal height and body weight at 9-14 years old in outpatient department of Pediatrics, Second Affiliated Hospital of Dalian Medical University, were selected at the same time. For the control group, the difference between the BMI, fasting blood glucose, fasting insulin and the HOMA-IR value before the medication in the children and the treatment group was compared. Statistically, for the data, the data conforming to the normal distribution were expressed as mean standard deviation ((?) + S), and compared with the t test, the data which did not conform to the normal distribution were expressed in the median (P25 P75), and the non parameters were used. The count data were compared with chi square test. The P values were calculated respectively. The difference was statistically significant by P0.05. At the same time, 1 cases of pediatric hospitalization in the second hospital affiliated to Dalian Medical University were diagnosed as T2DM and simple obese girls. The age was 10.58 years old. Hemoglobin, HOMA-IR and other indicators for 8 months. Results the average age, sex composition and fasting blood glucose of children in the 1. treatment group were not statistically significant (P0.05). The pre medication BMI, fasting insulin and Ln (HOMA-IR) in the treatment group were significantly higher than those in the control group. The difference was statistically significant (P0.001) the children of the.2. treatment group were given the mouth. After L2 weeks, the body weight was reduced from (74.66 + 15.02) kg to (71.91 + 14.19) kg after medication, and the difference was statistically significant (P=0.004). BMI was reduced from (29.36 + 4.42) kg/m~2 to (27.40 + 3.99) kg/m~2 before treatment. The difference was statistically significant (P0.001) and the difference was statistically significant (P=0.002).3. (P=0.002).3.. After L2 weeks of oral metformin treatment in the treatment group, the fasting blood glucose decreased significantly (P=0.002), Ln (HOMA-IR), fasting insulin, C peptide and glycosylated hemoglobin decreased significantly (P0.001) the difference was statistically significant (P0.001) in the.4. treatment group, 27 (65.85%) children (65.85%) were reduced to 3. after 12 weeks of oral metformin. Under 5, 24 (58.54%) children (58.54%) of children were reduced to less than 3.16 for L2 weeks after oral metformin for L2 weeks. The triglyceride decreased significantly (P=0.002), low density lipoprotein (P=0.002), low density lipoprotein (LDL) and total cholesterol (P0.001), but there was no statistical difference between HDL and HDL. Significance (P=0.635).6. reported 1 cases of type 2 diabetes and simple obesity girls, using metformin alone, the dynamic monitoring of fasting blood glucose decreased to normal in 3 days, glycated hemoglobin dropped to normal after February, and the HOMA-IR also decreased significantly in 4 cases (9.52%) in the process of oral metformin (9.52%). 1 cases of digestive tract reaction, 1 cases of diarrhea, nausea and abdominal distention in 3 cases, which occurred at 2 weeks before the medication, and were not disposed of and recovered spontaneously. Conclusion 1. metformin can reduce the weight of simple obese children and BMI.2. metformin can regulate the disorder of glucose metabolism in simple obese children, and the improvement of insulin resistance.3. metformin can reduce simplicity. Obese children's triglycerides, low density lipoprotein and total cholesterol.4. metformin can treat adolescent T2DM.
【學(xué)位授予單位】：大連醫(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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相關(guān)期刊論文 前10條

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本文編號：1918262