西格列汀、吡格列酮分别联合二甲双胍治疗难治性2型糖尿病的临床疗效对比研究

Comparative study between Sitagliptin with Mefformin and Pioglitazone with Metformin in treatment of patients with type 2 diabetes mellitus

目的观察并探讨西格列汀、吡格列酮分别联合二甲双胍治疗难治性2型糖尿病（T2DM）的临床疗效。方法将2012年5月-2013年10月间人选的86例T2DM患者随机分为A（n=42例）、B（n=36例）两组，A组患者予二甲双胍（MET）＋西格列汀（SITA）方案，B组予MET＋吡格列酮（PIO）方案，疗程12周，12周后对比两组血糖水平、临床疗效与药物不良反应。结果①治疗后，两组的空腹血糖（FBC）、餐后2h血糖（2hPG）及糖化血红蛋白（HbA1c）水平均明显低于治疗前，P〈0．05，A组患者的2hPG明显低于B组水平，t=2．496，P=0．015；②A组患者显效率（42．9％）、总体有效率（90．5％）略高于B组水平（31．8％、84．1％），差异无统计学意义，P〉0．05；③A、B两组用药期间药物不良反应发生构成无明显差异，P〉0．05，B组患者治疗后BMI高于A组，t=2．927，P=0．004。结论MET＋SITA与MET＋PIO方案均是治疗难治性T2DM有效方案，前者在临床疗效与餐后血糖控制方案具有明显优势，此外不会造成水钠潴留，临床安全性高。

Objective To observe clinical efficacy of sitagliptin ＋ metformin scheme and pioglitazone ＋ metformin scheme in treating refractory type 2 diabetes mellitus （T2DM）. Methods A total of 86 refractory T2DM patients admitted in General Hospital of CAPF between May, 2012 and October, 2013 were randomly divided into two groups, group A （n=42） and group B （n=44）. Group A was applied with MET＋SITA scheme while group B was applied with MET＋PIO scheme for a period of 12 weeks. The blood sugar, HbAIc, clinical efficacy and adverse drug reactions were compared between two groups. Results Blood sugar level, 2 hPG and HbAIc of both two groups after treatment were lower comparing with that before treatment,P 〈0.05.2 hPG of group A was significantly lower than that of group B,t =2.496,P =0.015.Significant effective rate（g2.9%）, overall effective rate （90.5%） of group A were both higher than those of group B （31.8%, g4.1%）, but the differences were not statistically significant,P 〉0.05.Adverse drug reactions of both group A and B reflected no significant difference during the treatment,P 〉0.05, BMI of group B was significantly higher than that of group A,t =2.927, P =0.004.Conclusion Both MET＋SITA and MET＋PIO scheme are effective regimes in treatment of refractory T2DM, the former excels in clinical efficacy and postprandial blood glucose controlling. In addition, it does not cause retention of water and sodium, carrying a higher safety feature.