胰岛素联合不同口服降糖药物对2型糖尿病患者颈动脉内中膜厚度和颈动脉粥样硬化斑块指数的影响研究

Effect of Insulin Combined with Different Antidiabetic Agents on Carotid Intima-media Thickness and the Carotid Artery Plaque Index

目的探讨胰岛素联合不同口服降糖药物对颈动脉内中膜厚度(CIMT)和颈动脉粥样硬化斑块指数的影响。方法选取2014年5—12月于烟台毓璜顶医院内分泌科住院的2型糖尿病患者137例为研究对象。根据采用的不同降糖方案分成3组:单用胰岛素组(胰岛素组)55例、胰岛素联合二甲双胍组46例、胰岛素联合阿卡波糖组36例。比较3组患者治疗前后的一般资料、血脂[三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)]水平、糖化血红蛋白(Hb A1c)水平、CIMT及颈动脉粥样硬化斑块指数。结果 (1)3组患者治疗前BMI及治疗后BMI、TG、TC比较,差异有统计学意义(P<0.05)。两两比较显示,治疗前、治疗后胰岛素联合二甲双胍组的BMI较胰岛素组、胰岛素联合阿卡波糖组高,治疗后胰岛素联合二甲双胍组TG、TC水平低于胰岛素组、胰岛素联合阿卡波糖组TG水平低于胰岛素组,差异有统计学意义(P<0.05)。(2)胰岛素联合二甲双胍组治疗后TG、TC、HDL-C、CIMT低于治疗前,胰岛素组颈动脉粥样硬化斑块指数高于治疗前,差异有统计学意义(P<0.05)。(3)3组患者CIMT治疗前后差值比较,差异无统计学意义(P>0.05);颈动脉粥样硬化斑块指数治疗前后差值比较,差异有统计学意义(P<0.05)。两两比较显示,胰岛素联合二甲双胍组、胰岛素联合阿卡波糖组颈动脉粥样硬化斑块指数治疗前后差值低于胰岛素组,差异有统计学意义(P<0.05)。结论胰岛素联合二甲双胍治疗可以减小患者的CIMT,胰岛素联合二甲双胍或阿卡波糖治疗可以延缓颈动脉粥样硬化斑块的增长速度。

Objective To study the effect of insulin combined with different antidiabetic agents on cartoid intimamedia thickness(CIMT)and carotid artery plaque index(PI)in type 2 diabetic patients.Methods One hundred and thirty-seven type 2 diabetic patients who received inpatient treatment in Endocrinology Department,Yantai Yuhuangding Hospital from May to December 2014,were enrolled and divided into insulin group(55 cases),insulin combined with metformin group(46 cases)and insulin combined with acarbose group(36 cases)according to the hypoglycemic regimen.Three groups'data about sex,age,course of type 2 diabetes,history of smoking and prevalence of hypertension were compared before treatment,and BMI,systolic pressure,blood lipid [triacylglycerol(TG),total cholesterol(TC),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C)],glycosylated hemoglobin(HbA1c),CIMT and carotid artery PI were compared before and after treatment.Results (1)The average BMI and TG and TC levels differed significantly between the groups either before or after treatment(P<0.05),to be specific,insulin combined with metformin group had higher average BMI than the other two groups(P<0.05);insulin combined with metformin group demonstrated lower average TG and TC levels than insulin group(P<0.05);insulin group showed higher average TG levels than insulin combined with acarbose group(P<0.05).(2)After treatment,the levels of TG,TC,HDL-C and CIMT decreased significantly in insulin combined with metformin group(P<0.05);carotid artery PI increased significantly in insulin group(P<0.05).(3)The CIMT reduction from pre-to-post treatment did not differ significantly between the 3 groups(P>0.05).However,the difference between the two measured values of carotid artery PI varied substantially between the groups(P>0.05).Specifically,insulin group showed much greater difference between the two measured values of carotid artery PI than the other two groups(P<0.05).Conclusion For type 2 diabetic patients,insulin combined with metformin can reduce the CIMT;the combination of insulin and metformin or acarbose can delay the progression of carotid artery plaque.