胰岛素泵短期治疗2型糖尿病合并乙肝病毒感染的疗效观察

The therapeutic effects of a short term CSII treatment of type 2 diabetes patients with hepatitis B virus (HBV) infection

目的分析合并乙肝病毒感染的初诊2型糖尿病患者胰岛素泵短期治疗的效果。方法回顾性分析曾接受胰岛素泵(CSⅡ)强化治疗2周的初诊2型糖尿病患者的临床特点,包括乙肝病毒感染组26例(HBsAg阳性,乙肝组),与乙肝组HbA_1c及年龄、性别、BMI相匹配的对照组52例(HBsAg阴性)。结果与对照组比较,乙肝组空腹血糖相对较低[(9.38±1.09)mmol/L vs (10.46±1.14)mmol/L],餐后2小时血糖较高[(19.61±3.92)mmol/L vs (16.78±3.15)mmol/L],乙肝组胰岛素、HOMA-β也高于对照组(P<0.05)。乙肝组在3月、6月、12月、24月及36月血糖维持达标率均高于对照组(P<0.05)。结论胰岛素泵治疗后2周停用降糖药物的第3,6,12,24,36周随访血糖达标缓解率乙肝组高于对照组。乙肝病毒感染可能对2型糖尿病患者糖代谢存在影响。

Objective To analyze the therapeutic effects of a short term CSII （continuous subcutaneous insulin infusion） treatment of type 2 diabetes （T2DM） patients with HBV infection. Methods Newly diagnosed T2DM patients receiving 2 weeks intensive therapy by CSII were retrospectively analyzed,including the HBV group（n=26） with positive HBsAg, and the control group（n =52） whose glycosylated hemoglobin, age, gender, BMI were matched to the HBV group. Then, the clinical features were compared between two groups. Results Fasting glucose were lower in HBV（＋） group than in HBV（-） group （9.38 ±1.09 vs 10. 46 ± 1.14mmol/L P〈0.01）, the 2-h postprandial glucose were higher in HBV（＋） group than HBV（--） group （19.61±3.92 vs 16.78±3.15 mmol/L P〈 0. 01）, and the fasting insulin level and HOMA-13 were higher in HBV（＋） group than in HBV（-） group （all P〈0.05）. The glucose target arrival rate was higher in HBV（＋） group than in control group at 3 months, 6 months, 12 months, 24 months and 36 months after stopping hypoglycemic medication（88. 5% vs73.1%,82.8% vs 61.5%,65.4% vs. 48.1%,42.3% vs 25.0%,11.5% vs 7.7%,allP〈0.05）. Conclusion During follow up at 3, 6, 12, 24 and 36 months after stopping 2 weeks of intensive CSII therapy, the glucose target arrival rates are higher in T2DM plus positive HBV group than in T2DM plus negative HBV group. The HBV infection may affect the glucose metabolism.