控制餐后血糖对颈动脉粥样硬化消退的观察

Regression of Carotid Atherosclerosis by Control of Postprandial Hyperglycemia in Type 2 Diabetes Mellitus

目的对比研究两种胰岛素促泌剂—瑞格列耐和格列苯脲对2型糖尿病患者颈动脉内膜-中膜厚度(Carotid intim a-m ed ia th ickness,C IMT)和血管炎性标志物(C-reactive prote in,CRP)的影响。方法68例2型糖尿病患者随机分为35例接受瑞格列奈治疗,33例使用格列苯脲治疗,观察治疗9个月前后C IMT的变化和血CRP的变化。结果治疗9个月后,瑞格列奈组餐后两小时血糖为(8.11±1.56)mmol/l,格列苯脲组餐后两小时血糖为(10±1.78)mmol/l(P<0.01)。两组的GHb都有相似程度的下降。瑞格列奈组(52%)格列苯脲组(18%)C IMT下降≥0.020mm(P<0.01)。瑞格列奈组CRP下降较格列苯脲组明显(P<0.05)。C IMT下降与餐后血糖峰值下降相关,与空腹血糖改变不相关。结论控制餐后血糖可使2型糖尿病患者颈动脉粥样硬化消退。

Objective We compared the effects of two insulin secretagogues, repaglinide and glyburide on carotid intima - media thickness （CIMT） and markers of systemic vascular inflammation C - reactive protein （CRP） in type 2 diabetic patients. Methods We performed a randomized, single - blind trial on 68 patients with type 2 diabetes mellitus. 35 patients were randomly assigned to receive repaglinide and 33 patients to glyburide, with a subsequent 9 - month treatment period. The effects of repaglinide and glyburide on CIMT and CRP were compared. Results After 9 months, postprandial glucose peak was （8.11 ± 1.56） mmol/1 in the repaglinide group and （ 10 ± 1.78 ） mmol/l in the glyburide group （ P 〈0.01 ）. GHb showed a similar decrease in both groups. CIMT regression, defined as a decrease of 0. 020 mm, was observed in 52% of diabetics receiving repaglinide and in 18% of those receiving glyburide （ P 〈0.01）. C -reactive protein decreased more in the repaglinide group than in the glyburide group（ P 〈 0. 05）. The reduction in CIMT was associated with changes in postprandial but not fasting hyperglycemia. Conclusion Reduction of postprandial hyperglycemia in type 2 diabetic patients is associated with CIMT regression.