格列美脲和格列苯脲治疗初诊2型糖尿患者时对心血管危险因素影响的对比研究

Comparision of glimepiride and glibenclamide on cardiovascular risk factors in patients with newly diagnosed type 2 diabetes mellitus

目的比较格列美脲和格列苯脲对初诊2型糖尿病患者糖、脂代谢及纤溶酶原活性等心血管危险因素的影响。方法比较格列美脲(n=333)和格列苯脲(n=232)治疗初诊2型糖尿病患者12周前后血糖、糖化血红蛋白、胰岛素抵抗改善情况,同时比较两组血脂及组织型纤溶酶原激活剂(tissue-typeplasminogenactivator,T-PA)和纤溶酶原激活剂抑制物1(plasminogen activator inhibitor-1,PAI-1)的浓度。结果与治疗前相比,格列美脲和格列苯脲治疗后患者血糖均达到良好控制,格列美脲组治疗后低血糖发生率低于格列苯脲组,差异有统计学意义(0.3%vs.1.7%,P<0.05)。格列美脲组治疗12周后,Homa-胰岛素抵抗比治疗前减少,差异有统计学意义(2.42%±0.91%vs.4.11%±0.85%,P<0.01);而在格列苯脲组,治疗前后Homa-胰岛素抵抗比较差异无统计学意义(P>0.05)。格列美脲组治疗12周后,血清总胆固醇、三酰甘油、低密度脂蛋白胆固醇浓度比治疗前显著下降,而血清高密度脂蛋白胆固醇浓度升高,差异有统计学意义(P<0.05);而格列苯脲组治疗前后血脂浓度比较,差异无统计学意义(P>0.05)。格列美脲治疗12周较治疗前明显升高t-PA,降低PAI-1,差异有统计学意义(P<0.05);而格列苯脲治疗前后t-PA、PAI-1比较,差异无统计学意义(P>0.05)。结论对初诊2型糖尿病患者,格列美脲具有快速稳定控制血糖、改善脂质代谢和显著减轻胰岛素抵抗、改善纤溶活性的作用。

Objectives To compare the effects of glimepiride and glibenclamide on blood glucose （BG） in patients with newly diagnosed type 2 diabetes mellitus （DMT2） in connection with plasma lipoproteins and plasminogen activity. Methods A total of 565 DMT2 patients was received glimepiride （n=333） or glibenclamide （n=232） for 12 weeks. We observed the level of BG, glyeated hemoglobin （HbA1C）, insulin resistance （IR） state, plasma lipoproteins, tissue-type plasminogen activator（t-PA ） and plasminogen activator inhibitor type Ⅰ （PAI-1 ） before and after a 12-weeks of treatment. Results After 12 weeks with glimepiride or glibenclamide treatment, significant reductions were observed in fasting blood glucose （FBG）,2-h postprandial BG （PBG） and HbA1C. Glycopenia rate in glimepiride group was significantly lower than that in glibenclamide group （0.3% vs. 1.7%, P〈0.05 ）. After 12 weeks with glimepiride, HOMAIR decreased （2.42%±0.91% vs.4.11%±0.85%,P〈0.O1）, and there was no significant difference in glibenclamide group. The concentrations of total cholesterol （TC）, triglyceride （TG）, and low-density lipoprotein cholesterol （LDL- C） were significantly decreased, whereas, high-density lipoprotein cholesterol （HDL-C） was increased markedly with statistical significance after 12 weeks with glimepiride; concentrations of TC, TG, LDL-C and HDL-C had no significant differences in glibenclamide group. In addition ,there was an obvious improvement in t-PA activity and the PAI-1 activity was decreased significantly in glimepiride group, and they had no significant change in glibenclamide group. Coneluslons Glimepiride can rapidly and stably improve glycemic control and lipoprotein metabolism, significantly alleviate insulin resistance and enhance fibrlnolytic activity in patients with newly diagnosed DMT2.