肾移植术后糖耐量异常与那格列奈的干预效应

Influence of Nateglinide on impaired glucose tolerance after renal transplantation

目的:肾移植术后糖耐量异常是肾移植成功与否的重要因素。观察那格列奈治疗肾移植术后糖耐量异常的临床疗效及安全性,并与阿卡波糖相比较。方法:①实验对象:选择2005-01/2006-06于首都医科大学附属北京友谊医院就诊的肾移植术后糖耐量异常患者50例,所有患者对治疗及实验方案均知情同意,且得到医院伦理道德委员会批准。②实验分组及方法:将50例患者按治疗用药不同分为2组(n=25):在原治疗方案不变的基础上,那格列奈组加那格列奈治疗;阿卡波糖组加阿卡波糖治疗。③实验评估:治疗前及治疗后4,12周时分别测定两组患者空腹血糖、餐后1h血糖、餐后2h血糖、胰岛素水平,在治疗过程中记录是否有低血糖症状及其他不良反应出现。结果:50例患者全部进入结果分析。①治疗后4周、12周相比,两组餐后1h血糖、餐后2h血糖水平差异均具有显著性意义(P=0.00)。治疗后4周、12周时,那格列奈组餐后1h血糖水平均低于阿卡波糖组(P=0.00)。②那格列奈组在治疗后12周时胰岛素水平明显高于阿卡波糖组(P=0.002)。③那格列奈组患者未出现明显不良反应;阿卡波糖组7例患者出现不良反应,其中低血糖反应3例。结论:与阿卡波糖相比,那格列奈能更有效地降低餐后1h血糖及保护胰腺细胞功能,低血糖反应发生率低,耐受性较好。

AIM： Abnormal glucose tolerance after renal transplantation determines the success of the operation. This study evaluated the effect and safety of Nateglinide on impaired glucose tolerance after renal tra-nsplantation, and compares them with Acarbose. METHODS： ①Fifty renal transplant recipients were selected from Beijing Friendship Hospital Affiliated to Capital Medical University between January 2005 and June 2006. The informed consent of treatment was obtained from all subjects, and the experiment was permitted by the Hospital Ethics Committee. ②According to the therapy, the patients were divided into two groups （n =25）： Nateglinide group, which was treated by Nateglinide besides original treatment, and Acarbose group, which was treated by Acarbose. ③The fasting glucose, 1 hour and 2 hours plasma glucose （lhPG and 2hPG） and insulin levels of all the patients were detected before and 4 and 12 weeks after treatment. Meanwhile, hypoglycemia and other adverse effects during treatment were recorded. RESULTS： All 50 subjects were involved in the result analysis. ①There were significant differences in lhPG and 2hPG between 4 and 12 weeks of treatment （P=0.00）. lhPG in Nateglinide group was lower than Acarbose group at 4 and 12 weeks of treatment （P =0.00）. ②The insulin levels of Nateglinide group at 12 weeks after treatment was higher than that in Acarbose group （P =0.002）. ③There were no obvious side effects in Nateglinide group. But side effects were found in 7 cases of Acarbose group, of which 3 were affected by hypoglycemia. CONCLUSION： Compared with Acarbose, Nateglinide appears to be more effective to reduce 1hPG, and better protect pancreatic gland function with low incidence of hypoglycemia and good tolerance.