胰岛素泵与皮下注射胰岛素对初诊2型糖尿病患者血管内皮功能的影响

Effects of Insulin Pumps and Subcutaneous Injection of Insulin on Vascular Endothelial Function of Type 2 Diabetes Mellitus Patients in Preliminary Diagnosis

目的观察胰岛素泵(CSII)与常规皮下注射胰岛素(MSII)治疗对初诊2型糖尿病血管内皮功能的影响。方法将2012年6月—2013年5月住院的42例初诊2型糖尿病随机分为CSII组22例和MSII组20例,CSII组采用胰岛素泵连续皮下胰岛素注射,MSII组采用多次皮下胰岛素注射,观察两组血糖控制情况,采用血管外超声检测肱动脉血流介导的内皮依赖性血管舒张功能(FMD)和硝酸甘油介导的内皮非依赖性血管舒张功能(NMD),同时测定收缩期血流介导的血管达到最大舒张内径所需时间(T1)和硝酸甘油介导的血管达到最大舒张内径所需时间(T2)。结果治疗后7 d和14 d两组全天血糖值均低于治疗前,除CSII组晚餐前0.5 h和MSII组睡前血糖外,两组其余时间点血糖均低于治疗后7 d,CSII组除治疗后14 d晚餐前0.5 h血糖外,其他时间血糖水平均低于MSII组(P<0.01,P<0.05);两组FMD、NMD治疗后14 d均高于治疗前,T1、T2均短于治疗前;CSII组FMD、NMD高于MSII组,T1低于MSII组相同时间血糖(P<0.05)。结论 CSII较MSII治疗初诊2型糖尿病血糖控制更理想,可以更好的改善患者血管内皮功能。

Objective To observe the effects of continuous subcutaneous insulin infusion （CSII） by insulin pump and multiple subcutaneous insulin injection （MSII） on vascular endothelial function of type 2 diabetes mellitus patients in preliminary diagnosis. Methods A total of 42 type 2 diabetes mellitus inpatients in preliminary diagnosis during June 2012 and May 2013 were randomly divided into CSII group （n = 22） and MSII group （n = 20）. CSII group was treated with con- tinuous subcutaneous insulin injection by insulin pump, while MSII group was treated with multiple subcutaneous insulin in- jection, and levels of controlling blood glucose in the two groups were observed. The flow-mediated dilation （FMD） and ni- troglycerin-mediated dilatation （NMD） in brachial artery were detected with ultrasonic testing, and the time （T1） of reac- hing the maximum dilatation diameter in blood vessels in systolic period and the time （ T2 ） of reaching the maximum dilata- tion diameter during NMD were detected synchronously. Results The values of all-day blood glucose 7 d and 14 d after treatment in two groups were significantly lower than those before treatment. The values of blood glucose on each time point in the two groups were lower than those of 7 d after treatment except for that of 30 min before dinner in CSII group and at bedtime in MSII group, the values of blood glucose 14 d after treatment on each time point in CSII group were significantly lower than those in MSII group except for that of 30 rain before dinner in CSII group （P 〈0. 01, P 〈0. 05） ; the values of FMD and NMD 14 d after treatment were significantly higher, and T1 and T2 were shorter than those before treatment in the two groups; compared with those in MSII group, values of FMD and NMD were higher and T1 was significantly shorter in CSII group （P 〈 0. 05 ）. Conclusion CSII can better control blood glucose, and improve vascular endothelial function than MSII in treatment of type 2 diabetes mellitus patients in preliminary diagnosis.