预混胰岛素对糖尿病合并肺部感染患者血糖控制及感染结局影响的临床研究

Effect of Premixed Insulin on Glycemic Control and Infection Outcomes in Diabetic Patients with Pulmonary Infection

目的 分析预混胰岛素对糖尿病合并肺部感染患者血糖控制及感染结局的影响。方法选取2011年12月至2012年12月南京军区南京总医院收治的肺部感染糖尿病患者共146例。采用随机数字表法将患者分为预混胰岛素甘舒30R组（72例）和二甲双胍组（74例）。其中预混胰岛素甘舒30R组患者采用预混胰岛素治疗,患者在餐前30 min进行皮下注射0.2~0.4 U/kg,连续治疗3个月;二甲双胍组患者采用常规口服二甲双胍500 mg/d,连续治疗3个月,比较两组患者血糖控制情况及感染结局。结果 两组患者治疗前空腹血糖、餐后2 h血糖及糖化血红蛋白比较差异无统计学意义（P〉0.05）;治疗3个月后,预混胰岛素甘舒30R组患者的空腹血糖、餐后2 h血糖及糖化血红蛋白水平均显著低于二甲双胍组[（5.2±0.7）mmol/L比（8.5±1.8）mmol/L、（7.6±0.3）mmol/L比（12.0±2.0）mmol/L、（5.66±1.24）%比（12.0±2.0）%,均P〈0.01],且两组空腹血糖、餐后2 h血糖及糖化血红蛋白水平均较治疗前显著下降（P〈0.05）;二甲双胍组患者高血糖的发生率显著高于预混胰岛素甘舒30R组[56.8%（42/72）比20.8%（15/74）,P〈0.05],而低血糖的发生率与预混胰岛素甘舒30R组比较差异无统计学意义[44.4%（32/72）比37.5%（27/74）,P〉0.05];两组患者治疗3个月后,预混胰岛素甘舒30R组患者临床总有效率明显高于二甲双胍组,差异有统计学意义（P〈0.05）。结论 预混胰岛素治疗糖尿病合并肺部感染患者能有效降低并且控制患者的血糖水平,提高肺部感染治疗的效果。

Objective To analyze the effect of premixed insulin on glycemic control and infection out- come in diabetic patients with pu]monary infection. Methods A total of 146 diabetic patients with lung infections in Nanjing General Hospital from Dec. 2011 to Dec. 2012 were chosen. According to random num- ber table method ,the patients were divided into Gan Shu 30R premixed insulin group（72 cases） and met- formin group（74 cases） group. Gan Shu 30R premixad insulin group was treated with pre-mlxed insulin ther- apy, the patients received subcutaneous injection of 0. 2- 0. 4 U/kg 30 min before meal, continuously for three months ; mefformin group was treated with conventional oral hypoglycemic agents 500 rng/d, continuously for three months, and the glycemic control and infection outcome of the two groups were compared. Results The fasting plasma glucose,2 h postprandial blood glucose and glycated hemoglobin in the two groups had no sta- tistically significant difference （ P 〉 0. 05 ） ; after 3 months treatment, the fasting glucose, 2 h postprandial blood glucose and glycated hemoglobin in Gan Shu 30R premixed insulin group were significantly lower than the mefformin group （5.2± 0.7 ） mmol/L vs （ 8. 5±1.8 ） retool/L, （ 7.6 ± 0. 3 ） mmol/L vs （ 12.0 ± 2. 0） retooL/L, （ 5.66 ± 1.24 ） % vs （ 12. 0 ±2. 0 ） %, P 〈 0. 05 ], and the two sets significantly decreased than before treatment（ P 〈0. 01. ） ; the incidence of hyperglycemia in patients of mefformin group was signifi- cantly higher than the Shu Gan 30R mixed insulin group [ 56. 8% （ 42/72 ） vs 20. 8% （ 15./74 ） , P 〈 0. 05 ], and the incidence of hypoglycemia had no statistically significant difference [ 44. 4% （ 32/72 ） vs 37.5 % （ 27/74 ）, P 〉 0. 05 ] ; after 3 months of treatment, the total effective rate of premixcd insulin 30 R Shu Gan group was statistically significantly higher than mcfformln group （ P 〈 0. 05 ）. Conclusion Premixad insulin can effectively reduce blood sugar levels in diabetes patients with pulmonary infection, and improve the treatment effect of pulmonary infection.