【摘要】：目的絕經(jīng)期糖耐量低減(IGT)患者給予小劑量螺內(nèi)酯聯(lián)合鹽酸吡格列酮片治療,對(duì)比患者血糖、胰島素抵抗指數(shù)、血脂、血壓、體質(zhì)指數(shù)(BMI)及不良反應(yīng)的變化。方法前瞻性研究經(jīng)葡萄糖耐量實(shí)驗(yàn)明確診斷的自然絕經(jīng)并IGT患者127例,根據(jù)隨機(jī)數(shù)字表法分為3組,分別給予鹽酸吡格列酮片15 mg/d單藥治療(A組,n=43)、鹽酸吡格列酮片聯(lián)合螺內(nèi)酯20 mg/d治療(A+S20組,n=42)及鹽酸吡格列酮片聯(lián)合螺內(nèi)酯40 mg/d治療(A+S40組,n=42),分別用藥24周后,分析患者空腹血糖(FPG)、餐后2 h血糖(2h PG)、糖化血紅蛋白(Hb A1C)、空腹胰島素(FIns)、餐后2 h胰島素(2h Ins)、胰島素抵抗指數(shù)(HOMA-IR)、三酰甘油(TG)、總膽固醇(TC)、血壓、BMI和其他不良反應(yīng)。采用數(shù)值變量單因素雙水平配對(duì)資料t檢驗(yàn)、數(shù)值變量單因素三水平方差分析和分類變量獨(dú)立樣本R×C列聯(lián)表醊2檢驗(yàn)。結(jié)果 (1)3組組內(nèi)用藥前后:2h PG、Hb A1C、FIns、2h Ins、HOMA-IR較前下降(P0.05),A組舒張壓(DBP)、TC下降,BMI增加(P0.05),A+S20組、A+S40組TC、TG、收縮壓(SBP)、DBP下降(P0.05)。(2)3組用藥后各組間對(duì)比:A+S20組與A組相比,FIns、HOMA-IR、TC、SBP、DBP、BMI下降(P0.05);A+S40組與A組相比,2h PG、Hb A1C、FIns、HOMA-IR、TC、SBP、DBP、BMI下降(P0.05);A+S40組與A+S20組相比,FIns、HOMA-IR、DBP下降(P0.05)。結(jié)論鹽酸吡格列酮片治療IGT患者,可有效改善患者血糖、HOMA-IR、血脂、血壓等水平,聯(lián)合小劑量利尿劑后HOMA-IR、血壓改善更加明顯,體重增加及水腫等不良反應(yīng)相應(yīng)減少,且未增加電解質(zhì)紊亂的風(fēng)險(xiǎn)。
[Abstract]:Objective to compare the changes of blood glucose, insulin resistance index, blood lipid, blood pressure, body mass index (BMI) and adverse reactions in patients with impaired glucose tolerance (IGT) treated with small dose of spironolactone combined with pioglitazone hydrochloride. Methods A prospective study was conducted on 127 patients with natural menopause and IGT diagnosed by glucose tolerance test. They were treated with pioglitazone hydrochloride for 15 mg/d (group A), pioglitazone hydrochloride combined with spironolactone for 20 mg/d (group A S20) and pioglitazone hydrochloride combined with spironolactone 40 mg/d (group A S40) for 24 weeks. Fasting blood glucose (FBG) 2 h postprandial blood glucose (HbA1C), fasting insulin (FIns), 2 h postprandial insulin (2 h Ins), insulin resistance index (HOMA-IR), triglyceride (TG), total cholesterol (TC), blood pressure and other adverse reactions) were analyzed. T test of single factor and double level matched data of numerical variable, analysis of three levels of variance of single factor of numerical variable and independent sample of classified variable R 脳 C linked table / 2 test were used. Results (1) before and after treatment, the HOMA-IR of HbHbA1C / FINS 2 h decreased in group A (P0.05). The decrease of (DBP) and TC in group A were increased (P0.05). The decrease of (SBP) in group A (P0.05), the decrease of (SBP) in group A (P05), and the decrease in BMI of group A (P 0.05) in group A and group A (P < 0.05) after treatment, the decrease of (DBP) in group A and group A was compared with that in group A (P0.05). (P0.05) in group A and group A, there was a decrease in BMI of (SBP) in group A and group A (P < 0.05), and the difference between group A and group A (P < 0.05) in comparison between group A and group A (P < 0.05) in comparison with group A, group A and group A (P < 0.05). Compared with the control group, the BMI of HbA1CU FInsOHMA-IRN TCU SBPnDBP decreased (P0.05), and that of AS-40 group was significantly lower than that of AS20 group (P0.05), and the level of FInsHoma -IRN DBP was significantly lower than that of A20 group (P0.05). Conclusion pioglitazone hydrochloride can effectively improve the levels of HOMA-IRL, blood lipid and blood pressure in patients with IGT. The improvement of blood pressure is more obvious in combination with low-dose diuretic, and the adverse reactions such as weight gain and edema decrease correspondingly. And did not increase the risk of electrolyte disorders.
【作者單位】： 天津市第一中心醫(yī)院內(nèi)分泌科;
【分類號(hào)】：R587.1

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