短期胰岛素泵治疗老年T2DM对患者血清hs-CRP、EL、8-iso-PGF2α水平的影响

Effects of continuous subcutaneous insulin infusion on levels of serum hs-CRP,EL,and 8-iso-PGF2αin elderly T2DM patients

目的探讨老年2型糖尿病(T2MD)应用短期胰岛素泵治疗对患者血清超敏C反应蛋白(hs-CRP)、内皮脂肪酶(EL)、8-异前列腺素F2α(8-iso-PGF2α)水平的影响。方法回顾性分析西北大学附属医院(西安市第三医院)2017年6月至2019年6月收治的90例老年T2MD患者的临床资料,依照治疗方法分组,其中47例采用短期胰岛素泵治疗者纳入A组,43例采用胰岛素多次皮下注射治疗者纳入B组,比较两组患者的血糖指标、血糖达标时间与日平均胰岛素用量、血糖波动参数、血清hs-CRP、EL、8-iso-PGF2α含量、低血糖发生率。结果A组患者治疗后空腹血糖(FPG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbAlc)水平分别为(6.87±0.65)mmol/L、(9.18±0.87)mmol/L、(6.97±0.65)%,明显低于B组的(7.34±0.70)mmol/L、(9.67±0.81)mmol/L、(7.45±0.72)%,差异均有统计学意义(P<0.05);A组患者的血糖达标时间为(7.29±0.69)d,明显短于B组的(11.24±1.19)d,日均胰岛素使用量为(33.69±3.24)U/d,明显少于B组的(42.78±4.17)U/d,差异均有统计学意义(P<0.05);A组患者治疗后的日内平均血糖波动幅度(MAGE)、全天血糖标准差(SDBG)、最大血糖波动幅度(LAGE)分别为3.59±0.32、1.44±0.12、7.29±0.64,明显低于B组的4.50±0.43、1.81±0.13、7.91±0.59,差异均有统计学意义(P<0.05);A组患者治疗后的血清hs-CRP、EL、PGF2a水平分别为(4.11±0.36)mg/L、(6.01±0.50)pg/mL、(82.69±8.51)ng/mL,明显低于B组的(5.03±0.49)mg/L、(6.62±0.57)pg/mL、(90.28±8.93)ng/mL,差异均有统计学意义(P<0.05);A组和B组患者分别发现低血糖事件65次和155次,A组低血糖事件发生频率为0.023次/(d·人),明显低于B组的0.060次/(d·人),差异有统计学意义(P<0.05)。结论短期胰岛素泵治疗可有效降低老年T2MD患者血糖水平,减轻血糖波动,同时还具有抗炎、降低氧化应激的效果,可减少低血糖事件发生率。

Objective To explore the effects of continuous subcutaneous insulin infusion(CSII)on levels of serum high-sensitivity C-reactive protein(hs-CRP),endothelial lipase(EL)and 8-isoprostanes F2α(8-iso-PGF2α)in elderly patients with type 2 diabetes mellitus(T2MD).Methods The clinical data of 90 elderly T2MD patients admitted to Affiliated Hospital of Northwest University and the Third Hospital of Xi'an from June 2017 to June 2019 were retrospectively analyzed.According to different treatment methods,47 cases treated with CSII were included in group A,while another 43 cases treated with multiple subcutaneous injection of insulin were included in group B.The blood glucose indexes,control time of blood glucose,daily average insulin dosage,blood glucose fluctuation parameters,contents of serum hs-CRP,EL,and 8-iso-PGF2α,and incidence of hypoglycemia were compared between the two groups.Results After treatment,levels of fasting blood glucose(FPG),2 h postprandial blood glucose(2hPG)and glycosylated hemoglobin(HbAlc)in group A were(6.87±0.65)mmol/L,(9.18±0.87)mmol/L and(6.97±0.65)%,respectively,which significantly lower than corresponding(7.34±0.70)mmol/L,(9.67±0.81)mmol/L,(7.45±0.72)%in group B(all P<0.05).The control time of blood glucose in group A was(7.29±0.69)d versus(11.24±1.19)d in group B,and daily average dosage of insulin in group A was(33.69±3.24)U/d versus(42.78±4.17)U/d in group B(P<0.05).After treatment,mean amplitude of glycemic excursions(MAGE),standard deviation of blood glucose(SDBG),and the largest amplitude of glycemic excursions(LAGE)in group A were 3.59±0.32,1.44±0.12 and 7.29±0.64,respectively,which were significantly lower than corresponding 4.50±0.43,1.81±0.13,7.91±0.59 in group B(all P<0.05).After treatment,levels of serum hs-CRP,EL,and PGF2a in group A were(4.11±0.36)mg/L,(6.01±0.50)pg/mL,(82.69±8.51)ng/mL,respectively,which were significantly lower than corresponding(5.03±0.49)mg/L,(6.62±0.57)pg/mL,(90.28±8.93)ng/mL in group B(all P<0.05).There were 65 times of hypoglycemia events in group A and 155 times in group B,respectively.The incidence of hypoglycemia events in group A was 0.023 times per day per person versus 0.060 times per day per person in group B(P<0.05).Conclusion CSII can effectively decrease blood glucose level in elderly T2MD patients,and reduce blood glucose fluctuations and oxidative stree,with anti-inflammatory effects.It can aslo reduce the incidence of hypoglycemia events.