盐酸吡格列酮治疗初发2型糖尿病对照研究

A control study of pioglitazone hydrochloride in the treatment of first-episode type 2 diabetes

目的 探讨盐酸吡格列酮治疗初发2型糖尿病的临床疗效. 方法 将248例初发2型糖尿病患者随机分为治疗组128例,对照组120例,两组均予以饮食控制、运动治疗、口服二甲双胍、胰岛素控制血糖及降脂等常规治疗,在此基础上治疗组加服盐酸吡格列酮治疗,观察3个月.于治疗前后测定两组空腹血糖、餐后2 h血糖、糖化血红蛋白、血脂四项、空腹免疫活性胰岛素、空腹真胰岛素、空腹胰岛素原,计算体重指数、胰岛素抵抗指数. 结果 治疗后两组空腹血糖、餐后2 h血糖、血清甘油三酯、血清总胆固醇、糖化血红蛋白、血清低密度脂蛋白胆固醇、空腹免疫活性胰岛素、空腹胰岛素原、胰岛素抵抗指数均较治疗前有显著下降（P＜0.01）,血清高密度脂蛋白胆固醇及空腹真胰岛素均较治疗前有显著升高（P＜0.01）,体重指数治疗前后则无显著变化（P＞0.05）.治疗前两组各项指标均无显著性差异,治疗后治疗组血清甘油三酯、空腹免疫活性胰岛素、空腹胰岛素原、胰岛素抵抗指数较对照组降低更显著（P＜0.01）,血清高密度脂蛋白胆固醇、空腹真胰岛素较对照组升高更显著（P＜0.01）. 结论 盐酸吡格列酮具有降糖调脂作用,能改善胰岛功能,临床效果显著,依从性好,可作为治疗2型糖尿病的一线降糖药物.

Objective To explore the clinical efficacy of pioglitazone hydrochloride in the treatment of first-episode type 2 diabetes. Methods 248 first-episode type 2 diabetes patients were randomly assigned to treatment （n：128） and control group （n=120）, both groups received such conventional therapy as alimentary control, movement therapy, oral metformin, blood glucose controlled with insulin and reducing blood fat, meanwhile the treatment group took orally pioglitazone hydrochloride for 3 months. Before and after treatment, such indexes were determined as blood-fasting sugar （BFS）, postprandial 2 hour blood glucose （PBG）, glycosylated hemoglobin （GH）, four items of blood lipid tests （FIBLT）, fasting immunoreactive insulin （FII）, fasting true insulin （FTI）, fasting proinsulin （FP）, and body mass index （BMI） and insulin resistance index （IRI） computed. Results After treatment, such indexes lowered more significantly as BFS, PBG, TG, total cholesterol, GH, LDL-ch, FII, FP and IRI （P〈0.01） and HDL-c and FTI heightened more significantly （P〈0.01） compared with pretreatment, there was no significant change in BMI between pre- and post-treatment （P〉0.05）. there were no significant differences in all indexes between the 2 groups before treatment, after treatment such indexes as TG, FII, FP and IRIlowered more significantly （P〈0.01） and HDL-c and FTI heightened more significantly （P〈0.01） in the treatment than in the control group. Conclusion Pioglitazone hydrochloride has hypoglycemic action and lipid modulation, can improve islet function, has better clinical efficacy and better compliance, can be served as firstline hypoglycemic agents in type 2 diabetes mellitus.