【摘要】：研究背景隨著經(jīng)濟的高速發(fā)展、生活水平的提高、生活方式的改變、人口的老齡化,2型糖尿病(type2diabetesmellitus,T2DM)發(fā)病率迅速增長,成為嚴重危害人類健康最重要的慢性非傳染性疾病之一[1]。根據(jù)2015年國際糖尿病聯(lián)盟(IDF)公布的第七版“IDF糖尿病地圖”顯示,在全球范圍內(nèi),20～79歲成人中約有8.8%的人患有糖尿病,這意味著全球約有4.15億糖尿病患者;中國糖尿病患者數(shù)達1.096億,居全球首位,其中2型糖尿病患者占糖尿病患者總數(shù)的90%以上。從上述調(diào)查數(shù)據(jù)看,我國的糖尿病現(xiàn)狀十分嚴峻,中國已成為全球范圍內(nèi)糖尿病患者增長最快的國家,并且已經(jīng)超過印度成為世界糖尿病第一大國[2]。不斷增加的糖尿病患者人數(shù)一方面對人類健康帶來極大的危害,另一方面也對社會經(jīng)濟的發(fā)展帶來巨大的醫(yī)療負擔。因此,糖尿病已成為全世界各國重大公共衛(wèi)生問題,而且糖尿病的防治重點應該放在2型糖尿病上。由于胰島β細胞功能障礙,2型糖尿病患者的胰島素分泌不足而致血糖升高。因此,針對2型糖尿病患者的治療,早期干預以改善β細胞功能就顯得非常重要。對于新診斷2型糖尿病患者,早期實施短期的胰島素強化治療,不僅能夠快速清除葡萄糖毒性,使得胰島β細胞的功能得到部分恢復;而且部分新診斷的2型糖尿病患者在一段時間內(nèi)有可能無需依賴降糖藥且能維持血糖達標。目的本論文旨在探討應用利拉魯肽聯(lián)合甘精胰島素治療新診斷2型糖尿病患者的療效。方法選取我院內(nèi)分泌科自2014年8月至2015年12月新診斷2型糖尿病患者61例,按照隨機數(shù)字表法分為兩組,觀察組(29例)給予利拉魯肽聯(lián)合甘精胰島素治療,對照組(32例)給予胰島素強化治療,分析比較兩組治療前后的療效。結(jié)果隨訪12周,全部患者的血糖和胰島素抵抗指數(shù)(空腹血糖FPG、餐后2h血糖2hPG、糖化血紅蛋白HbA1c、HOMA-IR)、血脂指標和體質(zhì)量指標在治療隨訪期間均有所下降,而HOMA-β,高密度脂蛋白-膽固醇HDL-C均有所上升,兩種治療方法均安全有效。然而,觀察組起效較快,在治療4周后,上述各項指標較治療前均明顯改善,而對照組需治療12周后,上述指標與治療前相比才有統(tǒng)計學差異。同時,觀察組在治療4和12周后,上述指標均顯著優(yōu)于對照組,差異具有顯著性(P0.05)。結(jié)論治療隨訪12周,利拉魯肽聯(lián)合甘精胰島素降糖、調(diào)脂、降體質(zhì)量和胰島功能恢復效果都顯著優(yōu)于胰島素強化治療,值得臨床推廣應用。
[Abstract]:Background with the rapid development of economy, the improvement of living standard, the change of life style, the aging of population and the rapid increase of the incidence of type 2 diabetes mellitus (type2diabetesmellitus,T2DM), It has become one of the most important chronic non-communicable diseases that seriously endanger human health [1]. According to the seventh edition of the IDF Diabetes Map published by the International Diabetes Alliance (IDF) in 2015, about 8.8 percent of adults aged 20 to 79 worldwide have diabetes, meaning that there are about 415 million diabetics around the world. China has 109.6 million diabetes patients, ranking first in the world, in which type 2 diabetes patients account for more than 90% of the total number of diabetes patients. According to the above-mentioned survey data, the present situation of diabetes in China is very serious. China has become the fastest-growing country in the world, and has overtaken India to become the world's largest diabetes mellitus country [2]. On the one hand, the increasing number of diabetes patients brings great harm to human health, on the other hand, it also brings huge medical burden to the development of social economy. Therefore, diabetes has become a major public health problem all over the world, and the prevention and treatment of diabetes should be focused on type 2 diabetes. Due to islet 尾-cell dysfunction, insulin secretion deficiency in type 2 diabetic patients leads to elevated blood glucose. Therefore, for the treatment of type 2 diabetes, early intervention to improve 尾-cell function is very important. For newly diagnosed patients with type 2 diabetes mellitus, short-term intensive insulin therapy can not only clear the glucose toxicity quickly, but also partially restore the function of islet 尾 cells. And some newly diagnosed patients with type 2 diabetes may not need to rely on hypoglycemic drugs for some time and keep their blood sugar up to standard. Objective to investigate the efficacy of lirapeptide combined with insulin in the treatment of newly diagnosed type 2 diabetes mellitus. Methods from August 2014 to December 2015, 61 newly diagnosed patients with type 2 diabetes mellitus were randomly divided into two groups: the observation group (n = 29) was treated with Lilalupin combined with insulin, and the patients in the observation group (n = 29) were divided into two groups according to the method of random number table. The control group (32 cases) were treated with insulin intensive therapy, and the curative effects before and after treatment were analyzed and compared between the two groups. Results after 12 weeks of follow-up, blood glucose and insulin resistance index (fasting blood glucose, 2 h postprandial blood glucose, 2 h PGG, glycosylated hemoglobin HbA1c,HOMA-IR), blood lipid and body mass index decreased, but HOMA- 尾, decreased in all patients after 12-week follow-up. High-density lipoprotein-cholesterol (HDL-C) HDL-C increased, and both treatments were safe and effective. However, the effect of the observation group was faster. After 4 weeks of treatment, all the above indexes were obviously improved compared with the pre-treatment, while the control group needed 12 weeks of treatment, the above-mentioned indexes had statistical difference compared with the pre-treatment. At the same time, 4 and 12 weeks after treatment, the above indexes in the observation group were significantly better than those in the control group, the difference was significant (P0.05). Conclusion after 12 weeks of follow-up, lirapeptide combined with insulin can reduce glucose, regulate lipid, decrease body mass and restore islet function significantly better than that of intensive insulin therapy. It is worth popularizing and applying in clinical practice. [WT5 "HZ] conclusion [WT5" BZ]
【學位授予單位】：南方醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R587.1

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