雷公藤多甙联合降糖治疗成人隐匿性自身免疫性糖尿病的临床疗效及安全性分析

Clinical Effect and Safety of Tripterygium Wilfordii Combined with Hypoglycemic Therapy in Treatment of Latent Autoimmune Diabetes of Adults

目的探究雷公藤多甙联合降糖治疗成人隐匿性自身免疫性糖尿病(LADA)的临床疗效及安全性。方法将2009年9月-2019年9月宜宾市第二人民医院就诊的38例LADA患者采用随机数字表法分为对照组(n=19,应用罗格列酮治疗)和观察组(n=19,对照组基础上联合雷公藤多甙治疗),比较治疗前及治疗24w后两组患者血糖控制情况[空腹血糖(FPG)、糖化血红蛋白(HbAlC)、空腹C肽]、T淋巴细胞亚群(CD3+、CD4+、CD8+)、胰岛自身抗体[胰岛细胞抗体(ICA)、谷氨酸脱羧酶抗体(GAD-Ab)],比较治疗24w期间两组患者药物不良反应发生率。结果治疗24w后,两组FPG、HbAlC、CD3+、CD4+均较治疗前显著降低,且观察组明显低于同一时间对照组(P<0.05);两组空腹C肽、CD8+水平均较治疗前显著升高,且观察组明显高于同一时间对照组(P<0.05);观察组ICA、GAD-Ab阳性转阴率均显著高于对照组(P<0.05)。治疗24w期间,两组药物不良反应率比较无统计学意义(P>0.05)。结论雷公藤多甙联合降糖治疗LADA具有显著疗效,可改善患者血糖控制情况及胰岛自身抗体水平,亦可对其细胞免疫功能进行有效调节,且用药安全性较好,对患者预后有利。

Objective To explore clinical effect and safety of tripterygium wilfordii combined with hypoglycemic therapy in treatment of latent autoimmune diabetes(LADA)of adults.Methods The paper chose 38 cases LADA patients in our hospital from September 2009 to September 2019,and divided them into control group(n=19,rosiglitazone treatment)and observation group(n=19,control group combined with tripterygium wilfordii treatment)randomly.Blood glucose control[fasting blood glucose(FPG),glycosylated hemoglobin(HbAlc),fasting C-peptide],T lymphocyte subsets(CD3+,CD4+,CD8+),islet autoantibodies[islet cell antibody(ICA),glutamic acid decarboxylase antibody(GAD AB)]was compared between two groups before and 24 weeks after treatment Results After 24 weeks of treatment,FPG,HbAlc,CD3+,CD4+of two groups were significantly lower than before treatment,levels of fasting C-peptide and CD8+in observation group were significantly higher than control group at the same time,(P<0.05).Positive conversion rates of ICA and GAD AB in observation group were significantly higher than control group,(P<0.05).During 24 weeks of treatment,there was no significant difference in adverse drug reactions rate between two groups(P>0.05).Conclusion Tripterygium wilfordii polyglycoside combined with hypoglycemic therapy can achieve significant effect on LADA,improve blood glucose control and islet autoantibody level,and regulate cellular immune function effectively,which is safe and beneficial to prognosis of patients.