瑞格列奈与那格列奈对新诊断2型糖尿病患者的疗效及胰岛β细胞功能的影响

Clinical efficacy of repaglinide and nateglinide in treatment of patients with newly diagnosed type 2 diabetes mellitus

目的探讨瑞格列奈和那格列奈对2型糖尿病患者的疗效及胰岛β细胞功能的影响。方法采用随机对照的方法,125例初诊、未经降糖药物治疗的2型糖尿病患者分为瑞格列奈治疗组(A组)65例和那格列奈治疗组(B组)60例,分别给予瑞格列奈(1mg,每天3次)或那格列奈(120mg,每天3次)治疗8周,治疗前及治疗后测定空腹血糖(FPG)、餐后血糖(PPG)、糖化血红蛋白(Hb A1c)、空腹胰岛素(FINS)、餐后胰岛素(PINS)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白(LDL)及高密度脂蛋白(HDL)。结果瑞格列奈及那格列奈治疗后空腹血糖(FPG)、餐后血糖(PPG)及糖化血红蛋白(Hb A1c)均有明显降低(P<0.01),瑞格列奈降低的更为明显(P<0.01);治疗后空腹胰岛素(FINS)和餐后胰岛素(PINS)均明显升高(P<0.05或P<0.01),而以那格列奈升高的更为明显(P<0.05或P<0.01);治疗后瑞格列奈组的胰岛素抵抗指数(HOMA-IR)明显降低(P<0.01),而那格列奈组未发现降低;治疗后2组胰岛β细胞功能指数(HOMA-B)均显著升高(P<0.01),而以那格列奈组升高的更为明显(P<0.01)。此外,那格列奈可以明显降低TC(P<0.01)、TG(P<0.01)和LDL(P<0.01),升高HDL(P<0.05),而未发现瑞格列奈组对脂质代谢有影响。结论那格列奈(1mg,tid)和瑞格列奈(120mg,tid)均能通过显著降低血糖而改善初诊2型糖尿病患者胰岛β细胞功能,胰岛素分泌量得到改善。瑞格列奈主要通过改善胰岛素抵抗发挥降糖作用,而那格列奈主要通过改善胰岛β细胞功能发挥降糖作用。

Objective To compare clinical efficacy of repaglinide and nateglinide in the treatment of type 2 diabetes mellitus（ T2DM） patients newly diagnosed. Methods 125 T2 DM patients were randomly treated with repaglinide（ 1mg tid,n = 65） or nateglinide（ 120 mg tid,n = 60） for eight consecutive weeks. Parameters of therapeutic effects（ FPG,PPG,Hb A1 c,FINS,PINS,TC,TG,LDL,HDL） were measured before and after treatment. Results After treatment for eight consecutive weeks,FPG,PPG and Hb A1 c showed significant decrease（ P〈0. 01）,and repaglinide had stronger effect on reducing FPG,PPG and Hb A1 c than nateglinide（ P〈0. 01）. FINS and PINS increased significantly in both groups（ P〈0. 05 or P〈0. 01）,and nateglinide had stronger effect on increasing FINS and PINS than repaglinide（ P〈0. 05 or P〈0. 01）. HOMA-IR had significantly reduced after treatment in repaglinide group,but the same result was not found in nateglinide group. Eight weeks later,HOMA-B significantly increased in both groups（ P〈0. 01）,and the increment in nateglinide group was more significant than that in repaglinide group（ P〈0. 01）. Moreover,nateglinide significantly reduced TC（ P〈0. 01）,TG（ P〈0. 01） and LDL（ P〈0. 01）,and significantly increased HDL（ P〈0. 05）,but the same results was not found in repaglinide group. Conclusion Repaglinide（ 1mg tid） and nateglinide（ 120 mg tid） both can improve pancreatic beta cell function in T2 DM patients newly diagnosed by reducing blood glucose. Moreover,repaglinide may decrease the level of blood glucose mainly through improving insulin resistance,and nateglinide probably reduce blood glucose mainly by improving beta cell function.