艾塞那肽对不同病程2型糖尿病患者治疗影响的研究

Effects of Exenatide on the Treatment for Different Disease Courses of Type 2 Diabetes Patients

目的:探讨艾塞那肽对不同病程2型糖尿病患者的疗效。方法:56例2型糖尿病患者按病程分为A、B组,A组32例,病程1年以内;B组24例,病程1～7年。2组患者发生酮症或空腹血糖>13.9mmol·L-1时给予胰岛素静脉滴注,血糖下降至<10mmol·L-1时改为持续皮下注射胰岛素强化治疗,纠正酮症或酮症酸中毒后改为胰岛素多次皮下注射;待血糖稳定后2组均皮下注射艾塞那肽3个月,第1个月5μg,bid,第2、3个月10μg,bid。如果空腹血糖<6mmol·L-1,胰岛素减量1～2U。比较2组治疗前、后肝肾功能、糖化血红蛋白(HbAlc)、血脂、72h动态血糖、静脉葡萄糖耐量试验等的变化。结果:治疗3个月后,A组体重指数、血压明显下降,治疗前、后比较差异有统计学意义(P<0.05),B组与治疗前比较差异无统计学意义(P>0.05);治疗3个月后,A组胰岛素用量减少,治疗前、后比较差异有统计学意义(P<0.05),B组与治疗前比较差异无统计学意义(P>0.05);治疗3个月后,2组空腹C肽、餐后2hC肽有升高趋势,总胆固醇、低密度脂蛋白有下降趋势,高密度脂蛋白有升高趋势,但差异无统计学意义(P>0.05)。结论:艾塞那肽治疗可降低2型糖尿病患者体重、血压,对病程1年以内患者效果更明显,并有望保护胰岛B细胞功能、调节血脂。

OBJECTIVE：To investigate exenatide on the treatment for different disease courses of type 2 diabetes patients.METHODS：56 cases of type 2 diabetes were divided into group A and group B,i.e.disease course of 32 cases were less than 1 year in group A and those of 24 cases were 1 to 7 years in group B.Two groups were given intravenous infusion of insulin when suffering from ketosis and fasting blood glucose was greater than 13.9 mmol·L-1.Intensive therapy of continuous subcutaneous injection of insulin was given when blood glucose decreased to 10 mmol·L-1,and multiple subcutaneous injection of insulin was given after correction of diabetic ketoacidosis.When the blood sugar kept stable,2 groups were added with subcutaneous injection of exenatide,5 μg,bid,in the first month,and changed to 10 μg,bid,1 month later;if the fasting blood glucose was less than 6 mmol·L-1,insulin decreased by 1～2 U;treatment lasted for 3 months.Liver and kidney function,HbA1c and blood lipids,72 h ambulatory blood glucose,intravenous glucose tolerance were all detected.RESULTS：After 3 months treatment,body mass index and blood pressure of group A decreased significantly after treatment,the difference was statistically significant（P0.05）;there was no statistical significance in difference of group B before and after treatment（P0.05）.After 3 months of treatment,insulin dosage reduced in group A,there was statistically significance before and after treatment（P0.05）;there was no statistical significance in difference of group B before and after treatment（P0.05）.After 3 months of treatment,fasting C-peptide,postprandial 2 h C-peptide and HDL tended to increase in 2 groups while total cholesterol and LDL was in a downward trend,but the difference had no statistical significance（P0.05）.CONCLUSION：Exenatide can reduce weight and blood pressure of patients with type 2 diabetes,especially for patients with less than 1 year disease course,and is expected to protect islet B-cell function and regulate blood lipids.