瑞格列奈及罗格列酮对肾移植后糖尿病患者的疗效

Effect of Repaglinide and Rosiglitazone in Patients of Posttransplant Diabetes Mellitus

目的:观察肾移植后糖尿病(PTDM)患者使用瑞格列奈或罗格列酮治疗的疗效及安全性。方法:筛查本中心PTDM患者共31例,随机分为瑞格列奈组16例(男9例,女7例)和罗格列酮组15例(男9例,女6例)。瑞格列奈组三餐前服用瑞格列奈1～2mg,罗格列酮组早餐前服用罗格列酮4～8mg,治疗6个月。观察2组治疗前后空腹血糖(FBG)、餐后2h血糖(2hPG)、糖化血红蛋白(HbA1c)、体质量指数(BMI)、天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)、尿素氮(BUN)和肌酐(Cr)等指标变化。持续高血糖需要加用胰岛素或其他口服降糖药物治疗者为治疗无效。结果:瑞格列奈组2例无效者改为瑞格列奈联合罗格列酮治疗或改为胰岛素治疗后效果满意;罗格列酮组4例治疗无效,改用胰岛素治疗,其中1例在治疗第2周时因水肿终止治疗(分析时予以排除)。瑞格列奈组和罗格列酮组治疗的有效率分别为87.5%(14/16)和71.4%(10/14),2组差异无统计学意义(P=0.378);2组FBG、2hPG、HbA1c和BMI治疗前后组内比较差别均有统计学意义(P<0.05),AST、ALT、BUN和Cr治疗前后组内比较差别均无统计学意义(P>0.05),2组各观察指标治疗前后的差值差别无统计学意义(P>0.05)。结论:罗格列酮及瑞格列奈对移植后糖尿病患者均有效,且对肝肾功能没有影响。

Objective：To investigate the efficacy and safety of repaglinide and rosiglitazone treatment in patients with renal posttransplant diabetes mellitus（PTDM）. Methods：Thirty-one PTDM patients were divided into 2 groups. Repaglinide（1-2 mg,three times/day before meals） and rosiglitazone （4-8 mg/day before breakfast）were used in the 2 groups respectively for 6 months. The values of fasting plasma glucose（FBG）,postprandial blood sugar（2 hPG）,glycosylated hemoglobin （HbA1c）,body mass index （BMI）,aspartate amino transferase（AST）,alanine aminotransferase（ALT）,urea nitrogen （BUN） and creatinine（Cr） were detected before and after the therapy. Results：The effective powers were 87.5% （14/16） and 71.4% （10/14） in repaglinide group and rosiglitazone group respectively and there was no significance between 2 groups （P = 0.378）. There were significant changes in the levels of PBG,2 hPG,HbA1c and BMI before and after treatment in 2 groups （P 〈0.05）. There were no significant changes in the levels of AST,ALT,BUN and Cr before and after treatment in 2 groups （P 〉0.05）. Conclusion：Repaglinide or rosiglitazone is an effective and safe treatment in patients with PTDM.