發(fā)布時間：2018-09-11 12:58

【摘要】：目的：隨著人們生活水平的提高及生活方式的改變,兒童胰島素抵抗的發(fā)病率呈明顯上升趨勢,兒童的胰島素抵抗已經(jīng)成為全世界醫(yī)生及患兒家屬尤為關心的問題。胰島素抵抗（insulin resistance,IR）是糖耐量異常、向心性肥胖、脂質(zhì)代謝紊亂，高血壓、高尿酸血癥，2型糖尿病，心臟病，代謝綜合癥，纖溶異常，甚至是育齡期婦女的多囊卵巢綜合癥（PCOS）等多種疾病的病理生理的基礎。研究報道我國城市學齡兒童肥胖的發(fā)生率已達10%-20%,肥胖兒童中胰島素抵抗的發(fā)病率約50%[1],隨著兒童肥胖和2型糖尿病的增加,以及兒童腎病綜合征等疾病糖皮質(zhì)激素應用的過程中所致的胰島素抵抗的副作用亦越來越明顯,因此兒童胰島素抵抗已經(jīng)成為臨床亟需解決的問題。如果我們能夠早期發(fā)現(xiàn)，早期診斷，并給予早期治療，則會使其成年時期相關疾病的發(fā)病率減少。本文通過對大連醫(yī)科大學附屬二院兒科收治的部分胰島素抵抗的患兒，給予二甲雙胍口服治療，觀察二甲雙胍對于存在胰島素抵抗的患兒的療效，用藥過程中注意觀察其不良反應并及時給予治療。 方法：本文通過選擇大連醫(yī)科大學附屬第二醫(yī)院兒科自2007年1月-2011年12月收治的確診有胰島素抵抗（IR）的患兒24例，其中單純性肥胖患兒10例，腎病綜合征應用糖皮質(zhì)激素治療過程中所致胰島素抵抗的患兒14例，所有患兒均給予二甲雙胍口服治療12周，觀察患兒治療前后空腹血糖，胰島素，血脂等指標的變化，計算胰島素抵抗指數(shù)（HOMA—IR)，從而評估二甲雙胍對于胰島素抵抗的療效，用藥過程中注意監(jiān)測患兒是否出現(xiàn)胃腸道反應，皮疹等不良反應并及時調(diào)整藥物劑量及予以對癥處理。 結(jié)果：口服二甲雙胍組治療l2周后與治療前相比，患兒的體質(zhì)指數(shù)由治療前的（25.5±2.1）降到治療后的（23.8±1.48）,TG由治療前的（2.01±1.10）mmol/L降至治療后的（1.43±0.48）mmol/L，LDL-L由治療前的（3.30±0.57）mmol/L降至治療后的（2.75±0.44）mmol/L；口服二甲雙胍治療12周后與治療前比較，患兒的體重，體質(zhì)指數(shù)，TG及LDL-L均下降,與治療前相比，差異具有統(tǒng)計學意義(P0.05)。 口服二甲雙胍組治療l2周后與治療前相比，血糖由治療前的(5.5±0.3)mmol/L降到治療后的(4.6±0.4)mmol/L，胰島素水平由治療前的(29.7±4.0)IU/ml降至治療后的(15.4±4.4)IU/ml，，胰島素抵抗指數(shù)由治療前的(4.3±1.5)降至治療后的(3.1±1.6)；口服二甲雙胍組治療l2周后與治療前相比，患兒的血糖，血胰島素水平，胰島素抵抗指數(shù)值明顯下降，治療前后比較，差異具有統(tǒng)計學意義（P0.05）。 本研究中，24例伴有胰島素抵抗的患兒均給予二甲雙胍治療12周，其中有18例（75％）患兒的胰島素抵抗指數(shù)恢復正常，體重較前明顯下降；所有服用二甲雙胍的患兒均沒有出現(xiàn)過敏、貧血等嚴重不良反應，僅有5例（21％）患兒有腹部不適和腹瀉的胃腸道癥狀,無其他不適癥狀，但患兒是可以耐受的。 結(jié)論：二甲雙胍可以改善葡萄糖代謝異常，降低體重和體脂，改善胰島素抵抗；二甲雙胍對于防治激素誘導的肥胖相關性腎病及單純性肥胖所致的胰島素抵抗具有重要意義。
[Abstract]:OBJECTIVE: With the improvement of people's living standard and the change of life style, the incidence of insulin resistance in children is increasing obviously. Insulin resistance in children has become a special concern of doctors and family members all over the world. Insulin resistance (IR) is an abnormal glucose tolerance, centripetal obesity and turbulent lipid metabolism. Chaos, hypertension, hyperuricemia, type 2 diabetes, heart disease, metabolic syndrome, fibrinolytic abnormalities, and even polycystic ovary syndrome (PCOS) in women of childbearing age are the pathophysiological basis of various diseases. With the increase of childhood obesity and type 2 diabetes mellitus, and the side effects of insulin resistance caused by glucocorticoid therapy in children with nephrotic syndrome, insulin resistance in children has become an urgent clinical problem. In this paper, metformin was given orally to some children with insulin resistance admitted to the Department of Pediatrics, Second Affiliated Hospital of Dalian Medical University, to observe the efficacy of metformin in the treatment of children with insulin resistance, and to observe its adverse reactions in the course of medication. Give treatment.
Methods: From January 2007 to December 2011, 24 children with insulin resistance (IR) were selected from the Department of Pediatrics, the Second Affiliated Hospital of Dalian Medical University. Among them, 10 were simple obese, 14 were nephrotic syndrome patients with insulin resistance induced by glucocorticoid therapy, and all were given dimethylbismuth. After 12 weeks of guanidine oral therapy, the changes of fasting blood glucose, insulin and blood lipid were observed before and after treatment, and the insulin resistance index (HOMA-IR) was calculated to evaluate the effect of metformin on insulin resistance. Symptomatic treatment should be given.
Results: Compared with before treatment, the BMI of the children in the oral metformin group decreased from (25.5 6550 After 12 weeks of metformin treatment, the body weight, body mass index, TG and LDL-L of the children were decreased compared with those before treatment, and the difference was statistically significant (P 0.05).
In the oral metformin group, blood glucose decreased from (5.5 + 0.3) mmol/L before treatment to (4.6 + 0.4) mmol/L after treatment, insulin level decreased from (29.7 + 4.0) IU/ml before treatment to (15.4 + 4.4) IU/ml after treatment, and insulin resistance index decreased from (4.3 + 1.5) before treatment to (3.1 + 1.6) after treatment. Compared with those before treatment, the levels of blood glucose, insulin and insulin resistance index in guanidine group decreased significantly after treatment for L2 weeks, and the difference was statistically significant (P 0.05).
In this study, 24 children with insulin resistance were treated with metformin for 12 weeks, of which 18 (75%) had normal insulin resistance index and significantly reduced body weight; all the children taking metformin had no serious adverse reactions such as allergy, anemia, and only 5 (21%) had abdominal discomfort and abdominal discomfort. Diarrhoea gastrointestinal symptoms, no other symptoms, but children are tolerable.
CONCLUSION: Metformin can improve glucose metabolism, reduce body weight and fat, and improve insulin resistance. Metformin is of great significance in preventing and treating hormone-induced obesity-related nephropathy and insulin resistance induced by simple obesity.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R725.8;R96

【參考文獻】

相關期刊論文 前10條

1 蘇曉艷;方朝暉;;瘦素及瘦素抵抗與肥胖、2型糖尿病的關系研究進展[J];安徽醫(yī)藥;2009年01期

2 魏濤,陳艷萍,段文若,馬永秀;女性單純性肥胖與內(nèi)分泌激素的相關性研究[J];標記免疫分析與臨床;2005年03期

3 張慶紅;;甘舒霖30R聯(lián)合二甲雙胍治療SFS75例分析[J];當代醫(yī)學;2009年18期

4 朱劍紅;;二甲雙胍對胰島素抵抗的臨床分析[J];當代醫(yī)學;2011年23期

5 黃永蘭;林文春;黃俊菁;張文;劉麗;;肥胖兒童胰島素抵抗和代謝綜合癥的臨床研究[J];中國兒童保健雜志;2011年02期

6 孫敏,劉超;糖皮質(zhì)激素和胰島素抵抗[J];國外醫(yī)學.內(nèi)分泌學分冊;2004年03期

7 竇梅;馬愛國;;胰島素抵抗主要原因及機制的研究進展[J];國外醫(yī)學(衛(wèi)生學分冊);2009年03期

8 劉曄;彭永德;;胰島素抵抗的炎癥機制及防治策略[J];世界臨床藥物;2012年03期

9 李優(yōu)鋒;程繼東;;二甲雙胍抗腫瘤作用機制的研究進展[J];廣東醫(yī)學;2012年03期

10 丁宗一 ,饒安伶 ,張t

本文編號：2236753