西格列汀联合胰岛素对2型糖尿病控制效果分析

Controlling Effect of Sitagliptin Combined with Insulin in Treatment of Patients with Type 2 Diabetes Mellitus

目的探讨西格列汀联合胰岛素对2型糖尿病(T2DM)控制效果及对血浆血管内皮生长因子(VEGF)、转化生长因子β1(TGF-β1)和C1q/TNF相关蛋白3(CTRP3)表达的影响。方法选取2016年5月—2017年5月我院收治的T2DM患者84例,按照用药方法分为观察组和对照组,每组42例。对照组住院期间予以糖尿病饮食,适当运动,胰岛素泵强化治疗控制血糖。出院后,予以诺和锐30控制血糖。观察组在对照组基础上加用西格列汀。分别于治疗前及治疗3个月,测定两组空腹血糖(FPG),空腹胰岛素(FINS),计算胰岛素抵抗(HOMA-IR)和敏感指数(ISI);餐后2 h血糖(2 h PBG),糖化血红蛋白(Hb A1c);总胆固醇(TC),甘油三酯(TG),高密度脂蛋白胆固醇(HDLC),低密度脂蛋白胆固醇(LDL-C)。检测两组血浆VEGF、TGF-β1和CTRP3水平;评估两组下肢动脉病变评分。结果治疗后,两组FPG、2 h PBG、Hb A1c、HOMA-IR、TC、TG、LDL-C、VEGF、TGF-β1水平和下肢动脉病变评分均较治疗前下降;且观察组低于对照组(P<0.05)。FINS、ISI、HDL-C和CTRP3均较治疗前升高,且观察组高于对照组(P<0.05)。结论西格列汀联合应用胰岛素治疗T2DM,在改善血糖、血脂等代谢指标的同时,也可调节血浆VEGF、TGF-β1和CTRP3等血管内皮细胞功能指标,从而延缓动脉粥样硬化的发生发展,改善T2DM血管病变。

Objective To investigate effects of Sitagliptin combined with insulin on controlling and expressions of plasma vascular endothelial growth factor（ VEGF）,transforming growth factor（ TGF-β1） and C1 q tumor necrosis factor related protein 3（ CTRP3） in patients with type 2 diabetes mellitus（ T2 DM）. Methods A total of 84 patients with T2 DM admitted during May 2016 and May 2017 were divided into observation group（ n = 42） and control group（ n = 42）according to medication methods. Control group was given diabetes diet,appropriate exercises,intensive insulin pump treatment during admission for control blood glucose,and then Novo Mix 30 was injected subcutaneously for controlling blood glucose after discharge. On the basis of the above treatments,observation group was treated with Sitagliptin. Before and in 3 months after treatment,fasting plasma glucose（ FPG）,fasting insulin（ FINS）,homeostasis model of assessment-insulin resistance index（ HOMA-IR）,insulin sensitivity index（ ISI）,2 hours postprandial blood glucose（ 2 h PBG）,hemoglobin A1 c（ Hb A1 c）,total cholesterol（ TC）,triglyceride（ TG）,high density lipoprotein-cholesterol（ HDL-C） and low density lipoprotein-cholesterol（ LDL-C） levels were detected in two groups. Levels of plasma VEGF,TGF-β1 and CTRP3 were detected by euzymelinked immunosorbent assay（ ELISA）. Lower extremity arterial disease scores were evaluated in two groups. Results After treatment,in two groups,values of FPG,2 h PBG,Hb A1 c,HOMA-IR,TC,TG,LDL-C,VEGF and TGF-β1 levels,and lower extremity arterial disease scores were significantly lower,and the values in observation group were lower than those in control group（ P〈0. 05）; while FINS,ISI,HDL-C and CTRP3 levels were significantly higher than those before treatment in two groups,and the values in observation group were higher than those in control group（ P〈0. 05）. Conclusion Sitagliptin combined with insulin in treatment of patients with type 2 diabetes mellitus may improve metabolism indexes such as blood glucose and blood lipid,and it has a certain regulatory effect on expression of vascular endothelial cell function indexes such as plasma VEGF,TGF-β1 and CTRP3 simultaneously so as to delay pathogenesy and development of atherosclerosis and improve vasculopathy induced by T2 DM.