初诊2型糖尿病胰岛素强化治疗诱导缓解的临床因素分析

Remission Induction Factor Analysis of patients with Newly Diagnosed Type 2 Diabetes Mellitus after Intensive Insulin Therapy

目的探讨初诊断2型糖尿病(type2 diabetes mellitus,T2DM)胰岛素强化治疗缓解的临床因素。方法收集作者医院2013-10/2015-02月收治的初诊断T2DM168例临床资料,胰岛素强化治疗后分为临床缓解组和未缓解组,比较2组临床特征,分析临床缓解相关因素。结果治疗前缓解组体质量指数(body mass index,BMI)、三酰甘油(triglyceride,TG)、空腹C肽(fasting C peptide,FCP)、脂肪肝合并率高于未缓解组(P<0.05);诊断时年龄、餐后2h血糖(2 hour postprandial blood glucose,2hPG)、糖化血红蛋白(glycosylated hemoglobin A1c,HbA1c)、冠心病合并率明显低于未缓解组(P<0.05)。空腹血糖(fasting blood glucose,FPG)、收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)、尿微量白蛋白(urinary microalbuminuria,UMA)、吸烟率、糖尿病家族史、酮症并发率及干预措施(初治胰岛素、二甲双胍、阿卡波糖、ACEI/ARB、他汀类使用量)相似,两组无统计学差异(P>0.05)。多因素分析结果显示,发病年龄小、高BMI、高TG、高FCP、合并脂肪肝为临床缓解的保护性因素。结论发病年龄小、高BMI、高TG、高FCP、合并脂肪肝,为初诊断T2DM患者胰岛素强化治疗后临床缓解有利因素。

Objective To explore the remission induction factors of patients with newly diagnosed type 2 diabetes （T2DM） after intensive insulin therapy. Methods ＇The clinic data of 168 newly diagnosed T2DM patients in authors＇ hospital from October 2013 to February 2015 were divided into clinical remission group and clinical non-remission group. The＇clinical characters of two groups were analyzed to explore the remission induction factors. Results The body ~ass index （BMI）, triglyceride （TG）, 2 hour postprandial blood glucose （2hPG） and fasting C peptide （FCP） of remission group were significantly higher than those of non-remission group （P〈0. 05） before treatment. In the remission group, the age, glycosylated hemoglobin A1 c （HbA1 c）, the complication ratio of fat liver and coronary heart disease were significantly lower than those of non-remission group. There were no significant difference （P〈0. 05） in fasting blood glucose （FPG）, systolic blood pressure （SBP）, diastolic blood pressure （DBP）, urinary micro-albluminuria （UMA）, the rate of smoking, family history and ketosis, the therapy （original insulin usage, Metform!n, Acarbose, angiotensin converting enzyme inhibitors/angiotensin II converting enzyme inhibitors, statins） of two groups. Binary logistic regression analysis suggested that the younger age, higher BMI, TG and FCP, higher complication ratio of fat liver were beneficial to the clinical remission. Conclusion The newly diagnosed T2DM patients rage, BMI, fat liver, TG, FCP may be the factors influencing the clinical remission of intensive therapy.