中药联合胰岛素泵对2型糖尿病患者胰岛β细胞功能和胰岛素抵抗的影响

Influences of Chinese herbal remedies combined with insulin pump on islet β-cell function and insulin resistance in patients with type 2 diabetes

目的观察中药联合胰岛素泵(CSII)治疗2型糖尿病(T2DM)的临床效果,精确评价联合用药对胰岛β细胞功能和胰岛素抵抗(IR)的作用。方法对10例初诊T2DM患者(联合组)采用中药联合CSII治疗,匹配空腹血糖值相同者(对照组)单纯CSII治疗,疗程1个月,检测血糖(PG)、糖化血红蛋白(HbA1C),高葡萄糖钳夹评价胰岛β细胞功能和IR情况。结果①治疗后2组双相胰岛素分泌均有升高,其联合组2相(2PH)胰岛素分泌均值和最大值高于对照组,差异有显著统计意义,P<0.05;②联合组胰岛素敏感指数(ISI)升高,t=-4.837,P=0.001;对照组ISI变化不显著,t=-1.655,P=0.132;2组ISI净升高值存在显著差异,t=4.364,P=0.002。结论中药联合CSII治疗T2DM可获得良好血糖控制,其机理可能是通过恢复胰岛β细胞对葡萄糖刺激的敏感性和改善IR而实现的。

Objective To observe the clinical effect of Chinese herbal remedies（CHR） combined with insulin pump（continuous subcutaneous insulin injection,CSII） in the treatment of type 2 diabetes,and review accurately the effects of the combination on islet β-cell function and insulin resistance.Methods The patients（n=10） with type 2 diabetes（the combined group） were treated with CHR combined with CSII,and the patients（n=10） with the same fasting plasma glucose value（the control group） were treated with CSII only.After one month the levels of plasma glucose（PG） and glycated hemoglobin（HbA1C） were detected.The islet β-cell function and insulin resistance were reviewed by hyperglycemic clamp technique.Results ①After the treatment the secretion of biphasic insulin increased in two groups,and in the combined group the average value and highest value of the secretion of biphasic insulin were all higher than those in the control group and the difference was significant statistically（P0.05）.②The insulin sensitivity index（ISI） increased in the combined group（t=-4.837,P=0.001）,and had no obvious change in the control group（t=-1.655,P=0.132）.The net increasing value of ISI was different significantly between two groups（t=4.364,P=0.002）.Conclusion CHR combined with insulin pump can control plasma glucose well in the treatment of type 2 diabetes,and the mechanism may be related to the recovery of islet β-cell sensitivity to glucose stimulation and the improvement of insulin resistance.