短期强化胰岛素治疗对初诊2型糖尿病患者下丘脑-垂体-肾上腺轴的影响

Study on the Effect of Short-term Intensive Insulin Therapy on Hypothalamus-Pituitary-Adrenal Axis Function of Newly Diagnosed Patients with Type 2 Diabetes

目的观察短期强化胰岛素治疗对初诊2型糖尿病（T2DM）患者血糖、血脂及下丘脑-垂体-肾上腺（HPA）轴功能的影响。方法对廊坊市中医院2012年1~12月收治的40例空腹血糖≥11.1 mmol/L的初发T2DM患者进行短期胰岛素泵强化治疗2周,比较其治疗前后血糖、血脂变化和高敏C反应蛋白水平,胰岛素分泌指数和胰岛素抵抗指数,治疗前后8：00、16：00、24：00患者的血浆皮质醇、促肾上腺皮质激素（ACTH）水平。结果 1治疗后,高敏C反应蛋白、空腹血糖、餐后2 h血糖、胰岛素抵抗指数、糖化血红蛋白较治疗前下降[（1.24±0.05）mg/L比（2.74±0.35）mg/L,（6.5±1.5）mmol/L比（12.3±1.6）mmol/L,（8.1±1.9）mmol/L比（15.6±3.4）mmol/L,（1.95±0.08）比（3.65±0.05）,（7.3±1.6）%比（9.3±2.2）%,P〈0.05];胰岛素分泌指数较治疗前显著增高[（41±6）比（17±3）,P〈0.05]。2治疗后,总胆固醇、三酰甘油、低密度脂蛋白胆固醇均较治疗前下降[（4.5±1.0）mmol/L比（5.7±0.9）mmol/L,（1.5±0.7）mmol/L比（2.5±1.8）mmol/L,（2.0±1.0）mmol/L比（3.6±0.9）mmol/L,P〈0.05];高密度脂蛋白胆固醇较治疗前明显增高[（1.2±0.3）mmol/L比（1.0±0.3）mmol/L,P〈0.05]。3治疗后,皮质醇各时点（8：00、16：00、24：00）较治疗前均显著降低[（505±87）nmol/L比（605±34）nmol/L,（174±46）nmol/L比（292±58）nmol/L,（42±6）nmol/L比（95±18）nmol/L,P〈0.05];ACTH各时点与治疗前比较差异无统计学意义（P〉0.05）。4全部病例随访12个月,1年后最终转归：18例予以口服降糖药,22例患者仅予生活方式干预。结论初诊T2DM疗效评价除需要监测血糖、血脂水平外,HPA轴功能的监测也可以作为评价T2DM血糖控制的指标,早期的胰岛素强化干预治疗是T2DM的重要治疗方案,具有普遍临床意义。

Objective To observe the effect of short-term intensive insulin therapy on the levels of blood glucose and blood lipid as well as hypothalamus-pituitary-adrenal （HPA） axis function of newly diagnosed patients with type 2 diabetes（T2DM）.Methods A total of 40 patients with primary onset of T2DM（fasting plasma glucose level≥11.1 mmol/L） admitted in Langfang Hospital of Traditional Chinese Medicine from Jan.2012 to Dec.2012 were given short-term intensive insulin pump treatment for 2 weeks.Levels of blood glucose and blood lipid and high sensitive C-reactive protein （ hs-CRP ） , and the insulin secretion index （HOMA-β）,insulin resistance index（HOMA-IR） before and after treatment,as well as levels of plasma cor-tisol and adrenocorticotrophic hormone（ACTH） at 8：00,16：00,24：00 before and after treatment were com-pared.Results ①Levelsofhs-CRP,fastingplasmaglucose（FPG）,plasmaglucose2hafterdinner,HOMA-IR,HBA1C were significantly decreased compared with those before treatment,there were statistically signifi-cant differences[（1.24 ±0.05） mg/L vs （2.74 ±0.35） mg/L,（6.5 ±1.5） mmol/L vs （12.3 ±1.6） mmol/L,（8.1 ±1.9） mmol/L vs （15.6 ±3.4） mmol/L,（1.95 ±1.08） vs （3.65 ±3.05）,（7.3 ± 1.6）% vs （9.3 ±2.2）%,P〈0.05];while HOMA-βlevel was significantly increased compared with that before treatment[（41 ±6） vs （17 ±3）,P〈0.05].②Levels of total cholesterol（TC）,triglyceride（TG）, low density lipoprotein cholesterol（LDL-C） were decreased than those before treatment[（4.5 ±1.0）mmol/L vs（ 5.7 ±0.9）mmol/L,（1.5 ±0.7） mmol/L vs （2.5 ±1.8）mmol/L,（2.0 ±1.0） mmol/L vs （3.6 ± 0.9） mmol/L,P〈0.05];level of high density lipoprotein cholesterol（HDL-C） was significantly higher than that before treatment[（1.2 ±0.3） mmol/L vs （1.0 ±0.3） mmol/L,P〈0.05].③After treatment,levels of cortisol at each time point（8：00,16：00,24：00） were significantly decreased compared with those before treat-ment[（505 ±87） nmol/L vs （605 ±34） nmol/L,（174 ±46） nmol/L vs （292 ±58） nmol/L,（42 ±6） nmol/L vs （95 ±18） nmol/L,P〈0.05];while there were no statistically significant differences of ACTH levels at each time point between before and after treatment（P＆gt;0.05）.④All the patients were followed up for 12 months,and got final prognosis after 1 years;among all the cases,18 cases were treated with oral hypo-glycemic agents,the other 22 patients were only treated with lifestyle intervention.Conclusion Concerning the evaluation of treatment effect on newly diagnosed patients with T2DM,it is not only necessary to monitor the levels of blood glucose and blood lipid,but also to take HPA axis function as another evaluation index of glycemic control in patients with T2DM.Early intensive insulin intervention therapy is important treatment method for patients with T2DM,with general clinical significance.