门冬胰岛素对Ⅱ型糖尿病患者心血管病变的影响

Effect of insulin aspart on cardiovascular disease in patients with type 2 diabetes

目的评价门冬胰岛素和常规人胰岛素对Ⅱ型糖尿病患者心血管病变发生率的影响。方法回顾性分析2012年1月至2013年12月在略阳县人民医院呼吸内分泌科治疗的759例Ⅱ型糖尿病患者的临床资料,根据患者用药方法不同,将患者分为常规人胰岛素组(n=373)和门冬胰岛素组(n=386)。对患者进行42个月的随访,比较两组患者的临床特征、患者累积生存率及心脑血管、大血管、微血管疾病发生率,评价门冬胰岛素治疗与患者并发症发生的相关性。结果与常规人胰岛素组比较,门冬胰岛素组患者大血管疾病、冠心病、心肌梗死与短暂性脑缺血发作(TIA)等并发症的发病率均明显降低,差异均有统计学意义(P<0.05);Cox回归模型分析表明,门冬胰岛素治疗是预防患者发生大血管疾病、冠心病、心肌梗死与中风/TIA并发症的保护因素(P<0.05);Kaplan-Meier曲线显示,门冬胰岛素组累积生存率显著高于常规人胰岛素组(79.6%vs 66.2%,HR=0.431,95%CI:0.258～0.782,P<0.01)。结论门冬胰岛素治疗能降低Ⅱ型糖尿病患者心脑血管及大血管病变的发病率,提高患者生存率,值得临床推广应用。

Objective To evaluate the effects of insulin aspart and conventional human insulin on the incidence of cardiovasculr disease in patients with type 2 diabetes. Methods The clinical data of 759 patients with type 2 diabetes mellitus, who treated in Department of Respiratory Endocrinology of the People＇s Hospital of Lueyang County during January 2012 and December 2013, were retrospectively analyzed. According to the different methods of administration, the patients were divided into the conventional human insulin group（n=373） and the insulin aspart group（n=386）. The patient was followed up for 42 months. The clinical characteristics, cumulative survival rate and incidence of cardiovascular and cerebrovascular, macrovascular and microvascular diseases were compared between the two groups.The correlation between insulin aspart and complication was evaluated. Results Compared with the conventional human insulin group, the incidence of complications of macrovascular disease, coronary heart disease, myocardial infarction, and transient ischemic attack（TIA） was significantly lower in the insulin aspart group, and the difference was statistically significant（all P〈0.05）. Cox regression model analysis showed that insulin aspart was the protective factor for major vascular disease, coronary heart disease, myocardial infarction and stroke/TIA complications（all P〈0.05）. The Kaplan-Meier curve showed that the cumulative survival rate of the insulin asparts group was significantly higher than that of the conventional human insulin group（79.6% vs 66.2%, HR=0.431, 95%CI 0.258-0.782, P〈0.01）. Conclusion The application of insulin aspart can reduce the incidence of cardiovascular and cerebrovascular and macrovascular diseases in patients with type 2 diabetes, and improve the survival rate of patients. It is worthy of clinical application.