本文選題：利拉魯肽 + 胰島素泵��； 參考：《延安大學(xué)》2015年碩士論文

【摘要】：目的:觀察利拉魯肽與胰島素泵聯(lián)合應(yīng)用對非初診2型糖尿病患者在控制血糖水平及減輕體重等方面治療前后的改善情況。評估兩藥聯(lián)合作用于非初診2型糖尿病患者的臨床效果,以期尋找更有效的降糖方案及合適的臨床劑量,為提高治療非初診2型糖尿病患者的臨床效果并減輕藥物的不良反應(yīng)提供理論和實驗依據(jù)。方法:1.選擇2013年1月~2015年1月在延安大學(xué)附屬醫(yī)院東關(guān)分院綜合內(nèi)科及榆林市中醫(yī)醫(yī)院北方醫(yī)院內(nèi)分泌科收治的45例非初診2型糖尿病患者,所有患者均進行糖尿病飲食、適量運動,研究期間禁用其它降糖藥物及影響諾和力活性成分的藥物。2.選取此45例患者隨機分為兩組,對照組21例,實驗組24例。對照組:在飲食運動的基礎(chǔ)上給予胰島素泵治療,根據(jù)血糖調(diào)節(jié)胰島素劑量;實驗組:在對照組的基礎(chǔ)上,加用利拉魯肽按0.6 mg/d漸遞增至1.2 mg/d治療。3.分別對比兩組患者在治療前及治療3個月后的空腹血糖(FPG)、餐后2小時血糖(PBG2h)、糖化血紅蛋白(HbA1c)、空腹C-肽(CP)、餐后1小時C-肽(1hCP)、空腹胰島素、餐后1小時胰島素、β細胞功能指數(shù)(HOMA-β)、胰島素抵抗指數(shù)(HOMA-IR)、血脂(TC、TG、HDL、LDL)、血壓、體重、體重指數(shù)(BMI)、腰臀比(WHR)、同型半胱氨酸(Hcy)、尿微量白蛋白(mAlb)。并且記錄兩組治療中低血糖反應(yīng)次數(shù)、胃腸道、肝功能損害等的不良反應(yīng);評價分析兩組治療前后胰島β細胞功能和胰島素抵抗改善情況。4.統(tǒng)計學(xué)分析使用SPSS22.0軟件統(tǒng)計包進行相關(guān)數(shù)據(jù)統(tǒng)計學(xué)處理,計量資料采用(x__±s)表示,組間比較采用t檢驗,組間計數(shù)資料采用四格表x2檢驗。檢驗標準:α=0.05,P0.05為差異有統(tǒng)計學(xué)意義。結(jié)果:1.兩組基線資料的比較,兩組入選病例在治療前從性別、年齡、fpg、pbg2h、hba1c、cp、1hcp、空腹胰島素、餐后1小時胰島素、homa-β、homa-ir、tc、tg、hdl、ldl、血壓、體重、bmi、whr、hcy、malb、alt、ast、ggt均差異不顯著(p0.05)。2.兩組治療前后血糖、糖化血紅蛋白的比較:實驗組治療前后的比較fpg(11.97±3.59vs6.29±1.22)、2hbpg(16.34±5.62vs7.36±2.17)、hba1c(11.97±4.59vs5.46±1.67),差異顯著(p0.05);對照組治療前后的比較:fpg(11.29±3.82vs6.97±1.19)、2hbpg(16.86±5.17vs7.34±2.62)、hba1c(12.46±3.67vs5.57±1.59),差異顯著(p0.05);實驗組與對照組治療后均可以有效控制fpg、2hpbg、hba1c,差異不顯著(p0.05)。3.兩組胰島素、c肽及β細胞功能方面相關(guān)參數(shù)的比較:實驗組治療前后的比較:cp(1.93±1.13vs3.08±0.98)、1hcp(2.30±1.63vs6.86±1.64)、空腹胰島素(8.70±0.85vs24.17±2.35)、餐后1小時胰島素(24.87±2.23vs66.58±2.08)、homa-ir(4.17±1.50vs2.34±1.23)、homa-β(16.57±11.50vs34.76±9.79),差異顯著(p0.05)。對照組治療前后的比較:cp(1.98±0.98vs2.43±1.13)、1hcp(2.86±1.64vs6.30±1.63)、空腹胰島素(9.15±0.15vs18.20±1.22)、餐后1小時胰島素(23.95±1.31vs46.55±2.11)、homa-ir(4.20±0.23vs2.77±1.50)、homa-β(16.80±10.97vs23.17±8.43),差異不顯著(p0.05);實驗組與對照組治療后,實驗組可以有效的改善cp、1hcp、空腹胰島素、餐后1小時胰島素、homa-ir、homa-β,降低胰島素用量,差異顯著(p0.05)。3.兩組體重、bmi及whr的比較:實驗組治療前后在改善體重、bmi及whr的比較:(83.63±11.22vs76.38±15.33)、(29.20±3.09vs25.01±3.12)(1.03±0.07vs0.85±0.06),差異顯著(p0.05);對照組治療前后在改善體重、bmi及whr的比較:(79.38±15.33vs82.63±10.23)(29.01±3.12vs29.54±3.10)(1.05±0.06vs1.06±0.07),差異不顯著(p0.05)。實驗組與對照組治療后比較,實驗組可以有效的改善體重、bmi及whr,差異顯著(p0.05)。4.兩組血脂方面相關(guān)參數(shù)的比較:實驗組治療前后在改善血脂方面相關(guān)參數(shù)的比較:tc(5.47±1.42vs4.37±1.39)、tg(4.59±3.09vs3.15±3.46)、hdl(1.15±0.49vs1.87±0.30)、LDL(3.34±1.23vs2.68±1.33)差異顯著(P0.05)。對照組治療前后在改善血脂方面相關(guān)參數(shù)的比較:TC(5.72±1.39vs5.52±1.43)、TG(4.18±3.46vs 4.15±3.13)、HDL(1.07±0.30vs1.16±0.53)、LDL(3.68±1.33vs1.16±0.53),差異不顯著(P0.05)。實驗組與對照組治療后比較,實驗組可以有效的降低TC、TG、LDL,增高HDL,差異顯著(P0.05)。5.兩組收縮壓、Hcy、mAlb的比較:實驗組治療前后收縮壓、Hcy、mAlb的比較:(134.31±13.12vs130.5±9.67)、(11.97±5.59vs8.46±4.67)、(50.42±8.55vs48.41±8.05),差異顯著(P0.05);實驗組治療前后舒張壓的比較,(75.31±10.13vs75.24±10.02)差異不顯著(P0.05)。對照組治療前后收縮壓、舒張壓、Hcy、mAlb的比較:(130.5±9.67vs132.31±12.13)、(75.43±10.52vs75.47±10.13)、(12.46±4.67vs13.57±4.53)、(51.23±8.54vs51.41±8.26),差異不顯著(P0.05)。實驗組和對照組在治療后,舒張壓均無明顯改變,實驗組可有效控制收縮壓、Hcy、mAlb,差異顯著(P0.05)。6.兩組不良反應(yīng)的比較:治療期間對照組有5例患者發(fā)生低血糖反應(yīng),發(fā)生率為23.81%;實驗組有1例患者出現(xiàn)低血糖反應(yīng),占總例數(shù)4.17%,差異顯著(P0.05)。治療過程中實驗組24例患者中有8例患者曾出現(xiàn)過惡心、腹瀉癥狀,占33.33%,有3例不能耐受退出;有4例患者曾出現(xiàn)過便秘癥狀,占16.67%;有1例患者出現(xiàn)流感樣癥狀(4.17%/24)退出實驗組,而對照組未見上述癥狀,故實驗組出現(xiàn)上述不良癥狀的次數(shù)明顯高于對照組,差異顯著(P0.05)。兩組治療前后ALT、AST、GGT均未見異常改變。結(jié)論:1.無論胰島素泵單用還是利拉魯肽與胰島素泵聯(lián)合應(yīng)用治療非初診2型糖尿病患者均可以平穩(wěn)控制血糖、降低HbA1c。2.利拉魯肽與胰島素泵兩藥聯(lián)合應(yīng)用可以減少胰島素劑量,明顯改善β細胞功能,改善胰島素抵抗。3.利拉魯肽與胰島素泵聯(lián)合應(yīng)用可以降低體重、血壓、血脂。4.利拉魯肽與胰島素泵聯(lián)合應(yīng)用比單獨應(yīng)用胰島素泵更能減少低血糖反應(yīng)的發(fā)生率。
[Abstract]:Objective: To observe the improvement of the treatment of non newly diagnosed type 2 diabetes patients before and after treatment with the combined use of L / L and insulin pump in the control of blood glucose level and weight reduction. To evaluate the clinical effect of the combined effect of two drugs on non newly diagnosed type 2 diabetes patients in order to find a more effective glucose lowering scheme and appropriate clinical dosage for the improvement of the clinical dosage. To provide theoretical and experimental basis for the treatment of non newly diagnosed type 2 diabetic patients and to reduce the adverse drug reactions. Methods: 1. to select 45 non newly diagnosed type 2 diabetic patients who were treated in the Department of Endocrinology, Dongguan branch of Affiliated Hospital of Yan'an University and the Department of endocrinology of the Northern Hospital of the Yulin traditional Chinese medicine hospital, January 2013, all patients with non newly diagnosed type 2 diabetes. The 45 patients were randomly divided into two groups, including 21 cases in the control group and 24 in the experimental group. The control group was treated with insulin pump treatment on the basis of diet exercise, and the insulin dosage was adjusted according to blood glucose; the experimental group was in the 45 cases: the experimental group: in the experimental group: in the experimental group: in the experimental group: in the experimental group: in the experimental group: in the experimental group: in the experimental group: in the experimental group: in the experimental group: in the On the basis of the group, mg/d was added to 1.2 mg/d by 0.6 mg/d to compare the fasting blood glucose (FPG) before and after 3 months of treatment, 2 hours postprandial blood glucose (PBG2h), glycated hemoglobin (HbA1c), fasting C- peptide (CP), 1 hours postprandial C- peptide (1hCP), fasting insulin, 1 hours postprandial insulin, beta cell work Energy index (HOMA- beta), insulin resistance index (HOMA-IR), blood lipid (TC, TG, HDL, LDL), blood pressure, weight, body mass index (BMI), waist to hip ratio (WHR), homocysteine (Hcy), urinary microalbumin (mAlb). And record two groups of adverse reactions in the treatment of hypoglycemia, gastrointestinal tract, liver function damage, and so on and before and after treatment of the two groups of pancreatic islet beta The improvement of cell function and insulin resistance.4. statistical analysis using SPSS22.0 software statistics package for statistical data processing, measurement data using (x__ + s), t test and four lattice x2 test for inter group count data. The test standard: alpha = 0.05, P0.05 for statistical significance. Results: 1. two groups of baseline Comparison of the data, two groups of selected cases from sex, age, age, FPG, pbg2h, HbA1c, CP, 1hcp, fasting insulin, homa- beta, homa- beta, HOMA-IR, TC, TG, HDL, LDL, blood pressure, weight, glucose, glycated hemoglobin, before and after treatment: before and after treatment in the experimental group before treatment After comparison of FPG (11.97 + 3.59vs6.29 + 1.22), 2hbpg (16.34 + 5.62vs7.36 + 2.17), HbA1c (11.97 + 4.59vs5.46 + 1.67), the difference was significant (P0.05); the comparison group before and after treatment: FPG (11.29 + 3.82vs6.97 +), 2hbpg (16.86 + 5.17vs7.34 + 2.62), HbA1c (12.46 + 1.59), significant difference; the experimental group and the control group were all treated after treatment. It could effectively control FPG, 2hpbg, HbA1c, and the comparison of the insulin, C peptide and beta cell function in.3. two groups: the comparison before and after treatment in the experimental group: CP (1.93 + 1.13vs3.08 + 0.98), 1hcp (2.30 + 1.63vs6.86 + 1.64), fasting insulin (8.70 + 0.85vs24.17 + 2.35), and 1 hours after meal insulin (24.87 + 2.23vs66.58 + 2.08) HOMA-IR (4.17 + 1.50vs2.34 + 1.23), homa- beta (16.57 + 11.50vs34.76 + 9.79), significant difference (P0.05). The comparison group before and after treatment: CP (1.98 + 0.98vs2.43 + 1.13), 1hcp (2.86 + 1.64vs6.30 +), fasting insulin (9.15 + 0.15vs18.20 + 1.22), 1 hours after meal (23.95 + 1.31vs46.55 + 2.11), HOMA-IR (4.20 + + + +), HOMA-IR Oma- beta (16.80 + 10.97vs23.17 + 8.43), the difference was not significant (P0.05), the experimental group and the control group after treatment, the experimental group can effectively improve the CP, 1hcp, fasting insulin, 1 hours after meal insulin, HOMA-IR, homa- beta, lower insulin dosage, the difference is significant (P0.05).3. two body weight, BMI and WHR comparison: experimental group before and after treatment to improve body weight, BMI BMI before and after BMI And the comparison of WHR: (83.63 + 11.22vs76.38 + 15.33), (29.20 + 3.09vs25.01 + 3.12) (1.03 + 0.07vs0.85 + 0.06), significant difference (P0.05). The comparison of the weight improvement, BMI and WHR in the control group was (79.38 + 15.33vs82.63 + 10.23) (29.01 + 3.12vs29.54 + 3.10) (29.01 + 3.12vs29.54 + 3.10) (1.05 + 0.06vs1.06 + 0.07), and the difference was not significant (P0.05). The experimental group was treated with the control group. After the treatment, the experimental group could effectively improve the weight, BMI and WHR, and the difference was significant (P0.05).4. two groups of blood lipid related parameters: the experimental group before and after treatment in the improvement of blood lipid related parameters: TC (5.47 + 1.42vs4.37 + 1.39), TG (4.59 + 3.09vs3.15 + 3.46), HDL (1.15 + 0.49vs1.87 + 0.30), LDL (3.34 + 1.23vs2.68 1.33) difference The relative parameters of the control group (P0.05) were compared before and after the treatment in the control group: TC (5.72 + 1.39vs5.52 + 1.43), TG (4.18 + 3.46vs 4.15 + 3.13), HDL (1.07 + 0.30vs1.16 + 0.53), LDL (3.68 + 1.33vs1.16 + 0.53), and no significant difference (P0.05). The experimental group was compared with the control group. DL, the difference of systolic pressure in group.5. two, Hcy, mAlb: the comparison of systolic pressure, Hcy, mAlb in experimental group before and after treatment: (134.31 + 13.12vs130.5 + 9.67), (11.97 + 5.59vs8.46 + 4.67), (50.42 + 8.55vs48.41 + 8.05), significant difference (P0.05), and the difference of diastolic pressure (75.31 + 10.13vs75.24 10.02) before and after treatment (75.31 + 10.13vs75.24 + 10.02) was not significant The comparison of systolic pressure, diastolic pressure, Hcy and mAlb before and after treatment in the control group: (130.5 + 9.67vs132.31 + 12.13), (75.43 + 10.52vs75.47 + 10.13), (12.46 + 4.67vs13.57 4.53), (51.23 + 8.54vs51.41 + 8.26), and no significant difference (P0.05). The diastolic pressure was not significantly changed in the experimental group and the control group, and the experimental group could effectively control the systolic pressure, Hcy, mAl. B, the difference of significant (P0.05).6. two groups of adverse reactions: during the treatment, 5 patients in the control group had hypoglycemia, the incidence of hypoglycemia was 23.81%; in the experimental group, 1 patients had hypoglycemic response, accounting for 4.17% of the total number of cases (P0.05). 8 patients in the 24 patients in the treatment process had had nausea, diarrhea symptoms, and 33.3 in the experimental group. 3%, 3 cases were unwell withdrawn; 4 patients had constipation symptoms, accounting for 16.67%; 1 cases had influenza like symptoms (4.17%/24) withdrawing from the experimental group, while the control group did not have the above symptoms, so the number of adverse symptoms in the experimental group was significantly higher than that of the control group (P0.05). The two groups had no abnormalities of ALT, AST, and GGT before and after treatment. Changes. Conclusions: 1. whether the single use of insulin pump or the combination of the insulin pump and the insulin pump in the treatment of non newly diagnosed type 2 diabetes patients can control the blood glucose smoothly, and the combination of the HbA1c.2. and the insulin pump two drugs can reduce the insulin dose, improve the function of beta cell and improve the insulin resistance.3. Li La Lu peptide. Combined use of the insulin pump can reduce weight, blood pressure, and blood lipid.4., and the combined use of the insulin pump is more likely to reduce the incidence of hypoglycemia than the use of the insulin pump alone.

【學(xué)位授予單位】：延安大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R587.1

【參考文獻】

相關(guān)期刊論文 前2條

1 蔡德海;宋光明;丁全福;;利拉魯肽人GLP-1類似物2型糖尿病的新療法[J];河北醫(yī)學(xué);2010年02期

2 賈偉平,項坤三,陸俊茜,陳蕾,唐峻嶺;中國人糖耐量異常與胰島素抵抗和胰島素分泌[J];中國糖尿病雜志;2000年02期

，

本文編號：1816941