格列美脲治疗糖尿病伴代谢综合征患者的临床观察

The clinical research of glimepiride in the treatment of diabetes mellitus accompanied by metabolic syndrome

目的研究格列美脲对糖尿病伴代谢综合征(MS)患者的治疗效果,并探讨其对胰岛素分泌功能和胰岛素敏感性的影响.方法对65例MS并存在糖尿病的患者给予格列美脲片1～8 mg/d,治疗12周,治疗前后测定空腹血糖(FPG),餐后2 h血糖(2hPG),空腹胰岛素(FIns)、餐后胰岛素(PIns)、糖化血红蛋白(HbA1c),计算胰岛素抵抗指数(HOMA-IR).并观察治疗前后血压、血脂及体重的变化.结果治疗12周后,FPG、2hPG和 HbA1c降低(P＜0.01),FIns无明显改变(P＞0.05),PIns增加(P＜0.01);HOMA-IR较治疗前明显降低(P＜0.01);治疗后体重指数、血压有轻微下降,但无统计学差异(P＞0.05),总甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)较治疗前有所改善(P＜0.05).结论格列美脲能有效改善MS中糖尿病患者的糖代谢状态,既能刺激PIns分泌,又能明显改善胰岛素的敏感性,且对MS的其它代谢异常无不良影响.

Objective To observe the clinical efficiency of glimepiride in the treatment of type 2 diabetes accompanied by metabolic syndrome and investigate the changes of insulin secretion and resistance before and after treatment. Methods 65 patients with metabolic syndrome and with type 2 diabetes were treated with glimepiride（ 1 - 8 mg/d） for 12 weeks. The fasting and postprandial plasma glucose and insulin levels （FPG, 2hPG, Fins and Pins, respectively）, glycnsylated hemoglobin（HbA1C） and lipid profile including triglycerides （TG） and high-density lipoprotein cholesterol （HDL-C） were measured before and after treatment.The blood pressure and body mass index（BMI） were also assessed and insulin resistance index（HOMA-IR） calculated. Results After 12 week treatment, the FPG, 2hPG and HbA1 c decreased significantly, P 〈 0.01 ;The Pins increased markedly（ P 〈 0.01 ）, but the Fins did not change significantly（ P 〉 0.05）, and the HOMA-IR decreased（ P 〈 0.01 ）. The lipid profile improved after treatment（ P 〈 0. 05）, and the BMI and blood pressure slightly decreased but no significant difference. Conclusions The glimepiride can effectively control the hyperglycemia of patients with metabolic syndrome,and improve the insulin resistance without any bad effect on other metabolison.