初诊2型糖尿病合并肺结核短期胰岛素强化治疗的疗效观察

Observation on the Effect of Short-term Insulin Intensification Therapy for Newly-diagnosed Type 2 Diabetes Mellitus Complicated with Pulmonary Tuberculosis

【目的】探讨短期胰岛素强化治疗初诊2型糖尿病（T2DM）合并肺结核患者的疗效和安全性。【方法】对本院2007年9月至2008年9月52例初诊T2DM合并肺结核患者随机分为强化治疗组26例，每日4次胰岛素皮下注射（三餐前使用诺和锐，睡前使用诺和灵N），血糖达标后改为诺和灵30R；对照组26例，每日早、晚餐前2次皮下注射诺和灵30R；观察12周，比较治疗后两组糖化血红蛋白、7个时点血糖、低血糖发生率、痰菌转阴情况及肺结核病灶X线变化。【结果】强化治疗组空腹和餐后血糖水平明显低于对照组（P〈0．05），两组低血糖发生率及胰岛素用量无显著性差异（P〉0．05），痰菌转阴率强化组（90．5％）显著高于对照组（71．4％）（P〈0．05）；两组患者治疗后肺部病灶改善例数分别为17例（65．4％）、13例（50．0％），强化治疗组显著高于对照组（P〈0．05）。【结论】初诊T2DM合并肺结核患者短期胰岛素强化治疗对血糖控制更为满意，对痰菌转阴和病灶改善更为有效，且低血糖反应发生率少，是一种较理想安全的治疗方案。

[Objective]To explore the effect and safety of short term insulin intensification therapy in trea ting newly-diagnosed type 2 diabetes mellitus complicated with pulmonary tuberculosis. [Methods] A total of 52 patients of newly-diagnosed type 2 diabetes complicated with pulmonary tuberculosis were randomly divided into two groups. One group was treated by NovoRapid after three meals and Novolin N before sleeping, and then changed by Novolin 30R after the control of blood glucose and the other by Novolin 30R. The contrast observation was conducted for 12 weeks. The blood sugar for 7 times a day was measured, and HbAlc,low blood sugar response and other side effects were also observed. Sputum conversion and chest X-ray were ob served. [Results] The level of blood sugar of intensification therapy was lower obviously than that of the con trast（ P 〈0.05）, and the rate of low blood sugar and amount of the use of insulin of the two groups have no statistically significant difference （ P 〈0. 05）. The rate of sputum conversion of intensification therapy was 90. 5 %,and that of the contrast was 71.4 %. There was statistically significant difference between the two groups （ P 〈0.05）. The number of the cases with absorption of chest X ray of intensification therapy was 17（65. 4%） and that of the contrast was 13（50.0%）, and that in the insulin intensification therapy group was higher than the contrast. [Conclusion]The effect of short term insulin intensification therapy in controlling blood sugar is more satisfied than that of the contrast. The rate of sputum conversion and the number of the cases with absorption of chest X-ray are high. The rate of low blood sugar is low. Thus, it is an effective and safe thera py method.