本文關(guān)鍵詞：早期胰島素泵強(qiáng)化治療對初診2型糖尿病患者遠(yuǎn)期頸動脈粥樣硬化及降糖方案的影響　出處：《山西醫(yī)科大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 胰島素泵 2型糖尿病 頸動脈粥樣硬化 頸動脈內(nèi)膜-中膜厚度

【摘要】：目的:本研究回訪初診使用胰島素泵降糖或口服降糖藥的2型糖尿病(T2DM)患者,觀察早期胰島素泵(CSII)降糖對初診T2DM患者遠(yuǎn)期頸動脈粥樣硬化(AS)的影響,觀察初診時胰島素泵治療對遠(yuǎn)期胰島功能的作用,探討初診降糖方式與遠(yuǎn)期血糖控制水平、降糖治療方案的關(guān)系,為初診糖尿病患者預(yù)防遠(yuǎn)期大血管并發(fā)癥、長期有效控制血糖提供理論依據(jù)。方法:回顧性研究2002年~2010年于北京軍區(qū)總醫(yī)院內(nèi)分泌科初診T2DM患者,依據(jù)病歷系統(tǒng)查閱入院病歷,2014年~2015年對符合納入標(biāo)準(zhǔn)患者進(jìn)行回訪,共回訪患者531位。根據(jù)初診有無應(yīng)用胰島素泵分為強(qiáng)化(CSII)組273例和口服降糖藥(OAD)組258例�；卦L時檢測一般臨床資料,詳細(xì)詢問患者近3個月降糖方案,并用B型超聲觀察頸動脈血管內(nèi)膜-中膜厚度(IMT)、血管病變情況等指標(biāo)。比較兩組間一般臨床資料、頸動脈IMT、斑塊陽性率、胰島功能有無差異,分析兩組藥物治療情況及血糖控制狀況,同時對頸動脈粥樣硬化的影響因素進(jìn)行分析。結(jié)果:1.分析初診資料,比較年齡、男女比例、病程、血壓(SBP/DBP)、體質(zhì)指數(shù)(BMI)、血脂指標(biāo)、空腹血糖(FPG)、空腹胰島素(FINS)、胰島素抵抗指數(shù)(H0MA-IR)、胰島β細(xì)胞功能(H0MA-β)、CIMT、斑塊陽性率,差異均無統(tǒng)計學(xué)意義(P0.05)。強(qiáng)化組(CSII)糖化血紅蛋白(HbA1c)高于口服藥(OAD)(P0.05)。531位初診T2DM患者頸血管斑塊陽性率是29.00%。強(qiáng)化組(CSII)頸斑塊陽性率達(dá)29.67%,口服藥組(OAD)頸斑塊陽性率達(dá)到28.29%。2.分析回訪時檢測指標(biāo),強(qiáng)化組年齡、男女比例、病程、血壓(SBP/DBP)、BMI、TC、TG、HDL-C、LDL-C、FPG、HbA1c與非強(qiáng)化組比較均未見明顯差別(p0.05)�；卦L時患者糖尿病平均病程為(8.98±2.57)年,其中回訪觀察最小時限為5年,最大時限為13年。3.比較回訪時兩組頸血管硬化指標(biāo),強(qiáng)化組(csii)cimt值為(0.72±0.28)mm,口服藥組(oad)頸動脈imt值為(0.77±0.25)mm,存在統(tǒng)計學(xué)差別(p0.05);頸動脈斑塊陽性率強(qiáng)化組(csii)是40.29%,口服藥組(oad)是49.61%,比較兩組斑塊陽性率存在統(tǒng)計學(xué)差異(p0.05)。4.比較回訪時fpg、hba1c、h0ma-ir(cp)、h0ma-β(cp),兩組fpg、hba1c、h0ma-ir(cp)均無統(tǒng)計學(xué)差異(p0.05)。強(qiáng)化組h0ma-β(cp)優(yōu)于口服藥組(p=0.012)。以hba1c≤6.5%作為血糖良好控制的切點(diǎn),強(qiáng)化組達(dá)標(biāo)率為22.71%;口服藥組(oad)達(dá)標(biāo)率是14.34%,兩組間血糖良好降低的達(dá)標(biāo)率存在統(tǒng)計學(xué)差異(p=0.013)。5.初診時強(qiáng)化組經(jīng)短期csii治療后,t2dm患者無藥緩解為118位,比率是43.22%;患者服用1種降糖藥的百分比達(dá)44.69%,聯(lián)合2種口服藥百分比達(dá)12.09%�？诜幗M(oad)采用短期單純口服降糖藥治療后,應(yīng)用1種口服降糖藥治療比率為79.07%,2種口服藥聯(lián)合使用的比率為16.28%,無藥緩解的患者比例為4.65%。6.回訪時強(qiáng)化組無藥緩解的比率為5.13%,單純口服藥治療為63.37%,口服藥聯(lián)合胰島素治療者為27.84%,僅使用胰島素比例為3.66%。非強(qiáng)化組患者均需使用藥物降糖,單純口服藥治療為55.43%,口服降糖藥聯(lián)合胰島素為24.03%,單純使用胰島素百分比達(dá)20.54%。各組間降糖藥物治療方式的組成比不全相同(p0.01)。7.對回訪時cimt與各觀察值實行相關(guān)分析:imt與年齡、hba1c、homa-ir、ldl-c呈顯著正相關(guān),與homa-β呈負(fù)相關(guān)。結(jié)論:1.初診2型糖尿病患者約29.00%合并頸動脈粥樣硬化。提示2型糖尿病患者初診時可能并發(fā)大血管病變,應(yīng)早期診斷及時治療。2.初診2型糖尿病患者早期應(yīng)用胰島素泵強(qiáng)化治療可以降低遠(yuǎn)期cimt,可能延緩糖尿病頸動脈粥樣硬化大血管病變的發(fā)生。3.初診2型糖尿病患者經(jīng)胰島素泵強(qiáng)化治療后長期胰島β細(xì)胞功能改善優(yōu)于初診口服降糖藥患者。4.初診2型糖尿病患者早期強(qiáng)化治療可影響遠(yuǎn)期降糖治療方案,部分患者可獲得長期臨床緩解狀態(tài)。
[Abstract]:Objective: This study revisits the use of hypoglycemic or oral antidiabetic drugs in newly diagnosed type 2 diabetes insulin pump (T2DM) patients, to observe the early insulin pump (CSII) on T2DM in patients with long-term diabetes carotid atherosclerosis (AS) effect of initial observation of insulin pump therapy on long-term islet function of newly diagnosed hypoglycemic and long-term blood glucose the level of control, hypoglycemic therapy for newly diagnosed diabetic patients, long-term prevention of macrovascular complications, long-term effective control of blood glucose and provide a theoretical basis. Methods: review of newly diagnosed T2DM patients in Department of endocrinology of General Hospital of Beijing Military Region on 2002 ~2010, according to medical records system access to medical records, 2014 ~2015 years to meet the inclusion criteria were a total of 531 patients with follow-up visit according to the diagnosis. There is no insulin pump divided into intensive (CSII) group and 273 cases of oral antidiabetic drugs (OAD) group of 258 cases. When the visit. Measuring the general clinical data, patients were asked in detail about the nearly 3 months of treatment, and the use of B ultrasonography to observe the carotid artery intima-media thickness (IMT), vascular disease and other indicators were compared between the two groups. The general clinical data, carotid artery IMT, plaque positive rate, there is no difference in islet function, analysis two drug treatment group and the control of blood glucose, and the influence factors of carotid atherosclerosis were analyzed. Results: 1. analysis of diagnostic data, age, sex ratio, disease duration, blood pressure (SBP/DBP), body mass index (BMI), blood lipid, fasting blood glucose (FPG), fasting insulin (FINS), insulin resistance index (H0MA-IR), islet beta cell function (H0MA-), CIMT, the positive rate of plaque, there were no significant differences (P0.05). The intensive group (CSII) of glycosylated hemoglobin (HbA1c) was higher than that of oral medicine (OAD) (P0.05) the positive rate of.531 T2DM in patients with carotid plaque 29.00%. augmentation group (CSII)棰堟枒鍧楅槼鎬х巼杈，

本文編號：1417998