胰岛素联合格列美脲治疗Graves病合并糖尿病患者疗效观察

Clinical effect of insulin combined with glimepiride in the treatment of patients with Graves' disease and diabetes mellitus

目的观察胰岛素联合格列美脲治疗Graves病合并糖尿病患者的临床疗效。方法选择2013年1月至2015年11月于我院治疗的94例Graves病合并糖尿病患者。依照简单随机数表法将患者随机分为观察组和对照组,每组47例,两组患者均服用甲巯咪唑(赛治)抗甲亢治疗,对照组另予以常规胰岛素控制血糖治疗,观察组则在使用常规胰岛素的基础上增用格列美脲控制血糖,治疗8周后比较两组患者的疗效及血糖、甲状腺相关激素水平。结果观察组患者甲亢的治疗总有效率为95.74%,与对照组的89.36%比较差异无统计学意义(P>0.05);组间比较,两组患者治疗前后的血清游离三碘甲状腺原氨酸(FT3)、血清游离甲状腺素(FT4)及促甲状腺激素(TSH)水平比较,差异均无统计学意义(P>0.05);组内比较,两组患者治疗后的FT3及FT4水平明显低于各组治疗前,但TSH水平明显高于各组治疗前,差异均有统计学意义(P<0.05);观察组患者糖尿病的治疗总有效率为97.87%,明显高于对照组的87.23%,差异有统计学意义(P<0.05);治疗后观察组患者的空腹血糖(FBG)、餐后2 h血糖(2 h BG)及糖化血红蛋白(Hb A1c)水平均明显低于治疗前,治疗后对照组患者的Hb A1c水平明显低于治疗前,差异有统计学意义(P<0.05),而FBG及2 h BG与治疗前相比,差异均无统计学意义(P>0.05)。治疗后观察组的FBG、2 h BG以及Hb A1c水平明显低于对照组,差异有统计学意义(P<0.05)。结论胰岛素联合格列美脲治疗Graves病合并糖尿病,能够有效改善患者的机体血糖代谢,有利于更好地提高临床疗效,且对甲亢疗效无明显影响。

Objective To study clinical effect of insulin combined with glimepiride in the treatment of patients with Graves＇ disease and diabetes mellitus. Methods A total of 94 patients with hyperthyroidism and diabetes, who admitted to our hospital from January 2013 to November 2015, were selected and randomly divided into the observation group and the control group according to the simple random number table method, with 47 cases in each group. Two groups of patients were treated with methimazole（Sai zhi） for anti-hyperthyroidism; the control group was additionally treated with conventional insulin to control blood glucose, and the observation group was treated with the additional use of glimepiride to control blood glucose on the basis of the use of conventional insulin. After 8 weeks of treatment, the clinical effects of the two groups of patients and the levels of blood glucose and thyroid-related hormones were compared. Results The total effective rate of hyperthyroidism was 95.74% in the observation group and 89.36% in the control group, and the difference was not statistically significant（P0.05）. There was no significant difference in the levels of serum free triiodothyronine（FT3）, serum free thyroxine（FT4） and thyroid stimulating hormone（TSH） between the two groups before and after treatment（P0.05）. The FT3 and FT4 levels in the two groups of patients after treatment were significantly lower than those before treatment, but the TSH levels were significantly higher than those before treatment, with statistically significant differences（P0.05）. The total effective rate after treatment of observation group patients was 97.87%, which was significantly higher than 87.23% of the control group patients（P0.05）. The levels of FBG, 2 h BG and Hb A1 c in the observation group patients after the treatment were significantly lower than those before treatment（P0.05）; the Hb A1 c level of the control group patients was significantly lower than that before treatment（P0.05）; while, there was no significant difference in the levels of FBG and 2 h BG in the control group before and after the treatment（P0.05）. After treatment, the levels of FBG, 2 h BG and Hb A1 c in the observation group patients were significantly lower than those in the control group patients（P0.05）. Conclusion Using insulin combined with glimepiride to treat Graves＇ disease and diabetes mellitus can effectively improve the patient＇s body glucose metabolism, which is conducive to enhance the clinical curative effect, with no significant effect on the curative effect of hyperthyroidism.