瑞格列奈治疗肾移植后糖尿病的疗效和安全性

A clinical study on repaglinide therapy of diabetes mellitus after renal transplantation

目的探讨瑞格列奈治疗肾移植后糖尿病(post-transplantation diabetes mellitus,PTDM)的疗效和安全性。方法收集2012-01至2014-06在我院确诊为肾PTDM并接受瑞格列奈治疗6个月的患者,观察治疗前和治疗后1、3、6个月空腹血糖、餐后2 h血糖、糖化血红蛋白、谷丙转氨酶、谷草转氨酶、碱性磷酸酶、总胆红素、直接胆红素、白蛋白、总蛋白、肌酐、尿素氮、尿酸水平和他克莫司浓度。结果共纳入病例32例,22例单用瑞格列奈即能达到满意疗效,剩余10例单用瑞格列奈血糖控制欠佳,采用瑞格列奈加甘精胰岛素血糖控制满意。治疗后1、3、6个月时的空腹血糖,餐后2 h血糖较治疗前均明显降低,差异有统计学意义(P<0.05);治疗6个月时糖化血红蛋白(6.20%±0.3%)水平较治疗前(7.50%±0.63%)明显降低(P<0.05);治疗前后肝肾功能各项指标和他克莫司浓度变化无统计学意义;治疗过程中发生6人次低血糖反应,最低血糖为3.7 mmol/L,无严重低血糖发生。结论瑞格列奈可作为肾PTDM患者一种安全有效的降糖药物。

Objective To study the efficacy and safety of repaglinide therapy in patients with post-transplantation diabetes mellitus（ PTDM）. Methods To all the patients diagnosed as having PTDM,recrnited in this hospital from January 1,2009 to June 30,2010 repaglinide was administered for 6 months. Glucose level,hepatic and renal function indicators and FK-506 concentration were examined at baseline,1 month,3 months and 6 months of repaglinide therapy. Results 32 patients were included. Except 10 patrents who required insulin glargine therapy due to their poor blood glucose control,the remaining 22 cases received satisfactory glycemic control with repaglinide alone. The levels of FBG,PBG at 1 month,3 months or 6 months of treatment were significantly lower than those at baseline respectively（ P〈0. 05）. The level of Hb1 AC at 6 months（ 6. 20% ± 0. 3%） was significantly lower than that at baseline（ 7. 50% ± 0. 63%; P〈0. 05）. Indicators of hepatic and renal functions and serum FK-506 concentration showed no significant change before and after repaglinide therapy. In the course of treatment hypoglycemia occurred 6 times,in which the lowest blood glucose level was 3. 7 mmol / L,no severe hypoglycemia oleveloped. Conclusions Repaglinide can be a safe and effective therapy in patients with PTDM.