胰岛素泵或胰岛素多次皮下注射对初发2型糖尿病并酮症患者胰岛素第一分泌时相及血清chem erin的影响

Influnce of insulin pump and insulin several times subcutaneous injections on the first phase insulin secretion and serum chemerin of patients with incipient type 2 diabetes Type and ketosis

目的探讨胰岛素泵持续皮下输注（CSII）或不同胰岛素多次皮下注射（MSII）对初发2型糖尿病（T2DM）并酮症患者胰岛B细胞分泌时相及血清chemerin的影响,提供CSII改善胰岛功能的新依据。方法选取2015年1~12月在我院进行治疗的初发T2DM并酮症患者60例,随机分为CSII组和MSII组,每组各30例。治疗4周,观察两组患者临床疗效,采用精氨酸刺激试验评估胰岛素分泌第一时相水平变化,采用ELISA法检测患者治疗前后血清chemerin水平的变化。结果两组治疗后空腹血糖（FBG）、餐后2 h血糖（2 h BG）、糖化血红蛋白（Hb A1c）浓度、体质量指数（BMI）、胰岛素抵抗指数（HOMA-IR）均低于治疗前（P〈0.05）。CSII组胰岛素平均使用量、血糖达标时间、低血糖发生率均低于MSII组,差异有统计学意义（P〈0.05）。两组治疗后较治疗前血清胰岛素第一时相分泌水平增高,chemerin水平降低（P〈0.05）。两种治疗方案对胰岛素第一时相分泌水平及血清chemerin水平的影响组间差异有统计学意义（P〈0.05）。结论 CSII较MSII能够更好地恢复胰岛素第一时相分泌,降低血清chemerin水平,其减轻胰岛素抵抗可能与chemerin水平下降有关。

Objective To explore the influence of continuous subcutaneous insulin infusion with pump（CSII） and multi subcutaneous insulin injection（MSII） on islet B cells secretory phase and chemerin level of patients with incipient type2 diabetic and ketosis. Methods 60 cases of incipient type 2 diabetes with ketosis treated in our hospital from January to December in 2015 were averagely divided into two groups：CSII group and MSII group,30 cases in CSII group were given continuous subcutaneous infusion with insulin pump,30 cases in MSII group were given multiple subcutaneous insulin injection;All were given continuous treatment for 4 weeks.The first phase insulin（1PH）function were assessed with arginine stimulation test.ELISA was used to detect the chemerin leve changes before and after treatment. Results The value of FBG,2 h BG,Hb A1 c,BMI and HOMA-IR after treatment significantly decreased than those of before treatment in both groups（P〈0.05）.Compared with MSII group,the average amount of insulin use,the time of good control of blood glucose,hypoglycemia rate significantly decreased in CSII group（P〈0.05）.The level of first phase insulin secretion increased,while the chemerin level decreased after treatment in both groups（P 0.05）.Difference had statistical significance in changes of the 1PH and chemerin level in both groups. Conclusion CSII can obtain better restoration on the first phase insulin secretion,decrease chemerin level,and increase insulin sensitivity than MSII,which may be associated with chemerin decline.