胰岛素泵联合门冬胰岛素与常规人胰岛素多次皮下注射治疗慢性阻塞性肺疾病合并糖尿病的疗效比较

Comparison of the clinical therapeutic effect between continuous subcutaneous insulin aspart infusion and multiple subcutaneous human insulin infusion in patients with chronic obstructive pulmonary disease and type 2 diabetes mellitus

目的探讨胰岛素泵(CSⅡ)联合门冬胰岛素治疗慢性阻塞性肺疾病急性加重期(AECOPD)合并2型糖尿病(T2DM)的临床疗效。方法选择AECOPD合并T2DM的患者101例,全部停用口服降糖药,在AECOPD常规治疗的基础上,随机分为胰岛素泵联用门冬胰岛素(CSⅡ)组(n=52例)和常规人胰岛素多次皮下注射(MSⅡ)组(n=49例),CSⅡ组应用胰岛素泵持续皮下输注基础量和三餐前皮下输注负荷量的门冬胰岛素(诺和锐),MSⅡ组每日4次皮下注射人胰岛素,三餐前用诺和灵R,22时用诺和灵N,观察两组治疗后血糖控制情况、血糖达标时间、每日胰岛素用量、低血糖发生率、AECOPD有效率和住院时间。结果两组治疗后空腹血糖(FPG)及平均三餐后2h血糖(2hPG)均较治疗前明显降低,且CSⅡ组较MSⅡ组降低更明显(P<0.05);CSⅡ组较MSⅡ组在血糖达标时间、每日胰岛素用量、AECOPD有效率和住院时间上差异均有统计学意义(P<0.01);CSⅡ组低血糖发生率较MSⅡ组降低(P<0.05)。结论胰岛素泵联合门冬胰岛素治疗AECOPD合并T2DM,既能有效地控制血糖,缩短血糖达标时间和住院时间,减少每日胰岛素用量,减少低血糖发生,又能提高AECOPD治疗有效率。

Objective To investigate the therapeutic effect of continuous subcutaneous insulin aspart infusion （CSII） in patients with chronic obstructive pulmonary disease with acute exacerbation（AECOPD） and type 2 diabetes mellitus. Methods 101 patients with AECOPD and type 2 diabetes mellitus were selected and stopped using oral hypoglycemic agents. Beside the routine theray for AECOPD, they were randomly divided into two groups： the continuous subcutaneous insulin aspart injection （CSII） （n= 52） and the multiple subcutaneous human insulin injection（MSII） （n = 49）. In the CSII group, the basal insulin aspart was continuously injected under the skin and the loading dose of insulin aspart before three meals . In the MSII group, human insulin Novolin R was used before three meals and Novolin N at 22： 00. The levels of blood glucose, glycemic control time, daily insulin dosage, the incidence of hypoglycemie attacks, effective percentage of AECOPD therapy and duration of hospitalization were compared between two groups. Results The levels of FBG and 2h postprandial blood glucose were significantly lower after therapy than before therapy in both groups, but the decreased extents of them in the CSII group were bigger than in MSII group （P〈0. 05）. Effective percentage of AECOPD improvement, reductions of glycemic control time, hospitalization time and daily insulin dosage in the CSII group were superior to those in MSII group（all P〈0.01）. Incidence rate of hypoglycemia in the CSII group were lower than in the MSII group （P〈0.05）. Conclusions CSII treatment of patients with AECOPD and type 2 diabetes mellitus is more efficient than MSII in controlling blood glucose, decreasing glycemic control time and hospitalization time, reducing the daily insulin dose and the incidence of hypoglycemia and increasing effective therapeutic percentage of AECOPD.