甘精胰岛素联合阿卡波糖治疗肝移植术后糖尿病的临床观察

Efficacy and safety of insulin glargine combined with acarbose in the treatment of patients with diabetes mellitus following orthotopic liver transplantation

目的观察甘精胰岛素联合阿卡波糖治疗肝移植术后糖尿病(PTDM)的疗效及安全性。方法肝移植术后糖尿病患者60例,随机分为A组(32例)和B组(28例)。A组给予甘精胰岛素皮下注射联合口服阿卡波糖,B组给予预混胰岛素(诺和灵30R)多次皮下注射,疗程均为3个月,治疗目标为FBG≤7.0mmol/L、2hBG≤10mmol/L。结果 50例患者完成治疗。治疗后两组患者血糖均达标,免疫抑制剂剂量均较治疗前降低(P<0.05)。A组治疗后胰岛素用量及低血糖发生率低于B组(P<0.05),两组急性排斥及其他不良事件比较,差异无统计学意义(P>0.05)。结论甘精胰岛素联合阿卡波糖应用于肝移植术后糖尿病患者可达到良好的血糖控制,且依从性较好。

Objective To observe the effect and safty of insulin glargine combined with acarbose in the treatment of patients with diabetes mellitus following orthotopic liver transplantation. Methods Totally 60 patients with diabetes mellitus following orthotopic liver transplantation were randomly divided into group A（insulin glargine plus acarbose, n= 32） and group B （ novolin 30R BID, n= 28）. During 3 months of treatment, blood glucose control and the incidence of hypoglycemia were observed. Results After treatment for 3 months, 50 patients（26 patients in group A and 24 patients in group B） completed the study . The daily glucose profiles , immunosuppressant doses （steroid and tacrolimus）and glycated hemoglobin levels significantly dropped in both groups（P〈0. 05）. The dosage of insulin and incidence of hypoglycemia were significantly lower in group A than in group B （P〈0.05）. The difference in rate of acute rejection and other side effects such as infection , hypertension and hyperlipemia were not statistically significant between the two groups（P〉0.05）. Conclusions Insulin glargine combined with acarbose is an effective and safe treatment for the patients with diabetes mellitus following orthotopic liver transplantation.