多因素干预对新诊断2型糖尿病患者代谢综合征的影响

Effects of multifactorial intervention of metabolic syndrome in newly-diagnosed type 2 diabetics

目的 探讨多因素干预对新诊断的 2型糖尿病 (T2DM )患者代谢综合征 (MS)的疗效。 方法 采用平行、开放的前瞻性研究方式 ,对 10 4例无动脉粥样硬化 (AS)伴MS的新诊断T2DM患者以抗血小板聚集 ,强化血糖、血压、血脂、体重等综合达标措施 ,探讨干预 1年对MS组成的变化。 结果 多因素干预 1年后伴MS的新诊断T2DM患者体质指数 (BMI)、糖化血红蛋白 (HbA1c)、甘油三酯 (TG)、收缩压 (SBP)及舒张压 (DBP)、2 4h尿白蛋白定量 ( 2 4hUAlb)、胰岛素抵抗指数(HOMA IR)、高敏C 反应蛋白 (hsCRP)水平、颈总动脉 (CCA)及股动脉 (FA)内中膜厚度 (IMT)均下降 (P <0 0 5 ) ;6 2 5 % ( 6 5 /10 4 )患者转变为无MS者 ,92 3% ( 96 /10 4 )患者减少至少 1项MS组分。干预 1年MS组分净达标率 (Δ % )依次为HbA1c( 6 0 6 % )、TG ( 4 5 2 % )、2 4hUAlb( 33 7% )、DBP( 33 7% )、SBP( 2 9 9% ) ,均高于BMI( 14 5 % )、HDL C( 13 5 % )及WHR( 1 9% ) (P <0 0 5 )。 结论 多因素干预可显著改善新诊断T2DM的MS ;各种MS组分对干预的疗效不一 ,中心性肥胖及低HDL C血症较难奏效。

Objective To explore the effect of multifactorial, targeted intervention of metabolic syndrome (MS) in newly diagnosed type 2 diabetic patients Methods 104 newly diagnosed type 2 diabetic patients without atherosclerosis(AS) were designed to experience the prospective targeted intervention, including the control of blood glucose, blood pressure, blood lipid and body weight, and taking aspirin as well The MS components were examined after 1 year intervention Results The levels of metabolic parameters such as BMI, HbA 1c,TG,sBP and dBP,24 hUAlb, HOMA IR, high sensivity C reactive protein, intimal media thickness of common carotid artery and femoral artery were significantly improved after one year intervention ( P <0 05) The 62 5% (65/104) patients with MS changed to the state without MS MS components in 92 3%(96/104) patients reduced at least one component The targeted percentages(Δ%)of MS components were significantly higher in HbA 1c(60 6%),TG(45 2%),24 hUAlb(33 7%),dBP(33 7%)and sBP(29 9%)than in BMI(14 5%),HDL C(13 5%)and WHR(1 9%)( P <0 05) Conclusions MS severity can be improved in newly diagnosed type 2 diabetic patients with MS after taking multifactorial, intensive intervention The effects of the intervention on MS components varies, central obesity and low HDL C level being tough for control during mutifactorial intervention