胰岛素持续皮下输注对2型糖尿病微血管病变影响的研究

Impact of Continuous Subcutaneous Insulin lnjection on Type 2 Diabetic Microangiopathy

目的:观察持续皮下胰岛素输注(CSII)对2型糖尿病(T2DM)微血管病变的影响。方法:80例T2DM微血管病变患者应用4周CSII强化治疗,比较治疗前后患者血清炎症因子:C-反应蛋白(CRP)、高敏C-反应蛋白(hsCRP);血清Ⅳ型胶原(CⅣ);纤溶因子:组织型纤溶酶原激活剂(t-PA)、组织型纤溶酶原激活剂抑制物(PAI-1)浓度的变化。结果:①T2DM微血管病变组患者CRP、hsCRP、CⅣ、PAI-1水平显著高于正常对照组(P<0.01),t-PA水平显著低于正常对照组(P<0.01)。②CSII治疗4周后空腹血糖、餐后2h血糖显著降低(P<0.01);糖化血红蛋白、胰岛素抵抗指数、CRP、hsCRP、CⅣ均降低(P<0.05);PAI-1显著降低(P<0.01),t-PA显著升高(P<0.01)。结论:T2DM微血管病变与血清炎症因子;CⅣ;纤溶因子有关,CSII治疗除能降血糖外,还能显著降低血清炎症因子、CⅣ水平,改善纤溶因子功能,减轻胰岛素抵抗。

Objective： To observe the effect of cominuous subcutaneous insulin infusion （CSII） on type 2 diabetic microangiopathy. Methods： A total of 80 patients with type 2 diabetic microangiopathy who received CSII intensive therapy for 4 weeks. The changes of serum inflammatory factors such as C-reaction protein （CRP）. Hypersensitive C-reaction protein （hsCRP）. Serum type iVcollagen （CIV） and fibrinolytic factors （tissue-type plasminogen activator t-PA, tissue-type plasminogen activator inhibitor PAI- 1） before and after treat- ment were compared. Results： CRP, hsCRP, serum CIVand PAI-1 in patient with type 2 diabetic microangiopathy were significantly higher than those in normal control group （P〈0.01）, while the level oft-PA was lower than that in normal control group （P〈0.01）. After 4 weeks of CSII therapy, the levels of FBG and 2h-postprandial glucose obviously decreased （P〈0.01）. And the level of HbAlc, insulin resistance in- dex （IRI）, CRP, hsCRP and CIV all decreased （P〈0.05）, and the level of PAI-1 significantly decreased （P〈0.01）, while the level of t-PA obviously increased （P〈0.01）. Conclusion： Type 2 diabetic microangiopathy is correlated with serum inflammatory factors, CIV and fibri- nolytic factors. CSII therapy not only can decrease the blood glucose, but also obviously reduce serum levels of inflammatory factor and CIV, and improve the function of fibrinolytic factors, and reduce insulin resistance.