羟苯磺酸钙联合短期胰岛素强化疗法对2型糖尿病合并大血管病变患者临床疗效的影响

Effect of Calcium Dobesilate Combined with Short-term Intensive Insulin Therapy on Clinical Efficacy of Type 2 Diabetes Mellitus Complicated with Macrovascular Disease

目的分析羟苯磺酸钙联合短期胰岛素强化疗法对2型糖尿病(T2DM)合并大血管病变患者临床疗效的影响。方法选取2019年2月至2021年2月榆林市第二医院内分泌科收治的126例T2DM合并大血管病变患者作为研究对象,根据治疗方式不同分为对照组(60例)和研究组(66例)。其中,对照组采用短期胰岛素强化治疗,研究组采用羟苯磺酸钙联合短期胰岛素强化治疗,每次0.5 g,每日3次。两组均治疗3个月。治疗3个月后,比较两组血糖指标[空腹血糖(FPG)、糖化血红蛋白(HbA 1c)]、血小板最大聚集率(MAR)、血小板电泳率(PER)、炎症因子[白细胞介素(IL)-16、IL-18]、血管内皮生长因子(VEGF)、颈动脉内膜中层厚度(IMT)、斑块面积变化以及不良反应发生情况。结果FPG、HbA 1c水平时点间的主效应差异有统计学意义(P<0.01),组间的主效应差异无统计学意义(P>0.05),时点间与组间不存在交互作用(P>0.05)。与治疗前相比,治疗后两组的FPG、HbA 1c水平均降低(P<0.05)。MAR、PER时点间、组间的主效应差异有统计学意义(P<0.01),时点间与组间存在交互作用(P<0.01)。与治疗前相比,治疗后两组MAR降低(P<0.05),而PER升高(P<0.05);且与对照组相比,研究组的MAR更低(P<0.05),PER更高(P<0.05)。IL-16、IL-18水平时点间、组间的主效应差异有统计学意义(P<0.01),时点间与组间存在交互作用(P<0.01)。与治疗前相比,治疗后两组的IL-16、IL-18水平均降低(P<0.05);且与对照组相比,研究组的IL-16、IL-18水平更低(P<0.05)。VEGF、IMT、斑块面积时点间、组间的主效应差异有统计学意义(P<0.01),时点间与组间存在交互作用(P<0.01)。与治疗前相比,治疗后两组的VEGF、IMT、斑块面积均降低(P<0.05);且与对照组相比,研究组的VEGF、IMT、斑块面积更低(P<0.05)。对照组与研究组的不良反应发生率比较差异无统计学意义[0比3.03%(2/66)](P>0.05)。结论羟苯磺酸钙联合短期胰岛素强化疗法更有利于改善T2DM合并大血管病变患者的血小板功能,降低炎症因子水平,延缓大血管病变程度,且安全性高。

Objective To analyze the effect of calcium dobesilate combined with short-term intensive insulin therapy on the clinical efficacy of type 2 diabetes mellitus(T2DM)patients with macrovascular disease.Methods A total of 126 patients with T2DM complicated with macrovascular disease admitted to the Endocrinology Department of Yulin Second Hospital from Feb.2019 to Feb.2021 were included,and divided into a control group(60 cases)and a study group(66 cases)according to different treatment methods.The control group was treated with short-term intensive insulin therapy,while the study group was treated with calcium dobesilate combined with short-term intensive insulin therapy,0.5 g each time,3 times a day.Both groups were treated for 3 months.After 3 months of treatment,the blood glucose indexes[fasting plasma glucose(FPG),glycosylated hemoglobin(HbA 1c)],maximal aggregation ratio(MAR),platelet electrophoresis rate(PER),inflammatory factors[interleukin(IL)-16,IL-18],vascular endothelial growth factor(VEGF),carotid intima-media thickness(IMT),plaque area changes and adverse reactions were compared between the two groups.Results The main effect differences of FPG and HbA 1c level between time points were statistically significant(P<0.01),but there was no significant difference between groups(P>0.05),and there was no interaction between time points and groups(P>0.05).Compared with before treatment,the levels of FPG and HbA 1c in both groups were decreased after treatment(P<0.05).The main effect differences of MAR and PER between time points and between groups were statistically significant(P<0.01),and there were interactions between time points and groups(P<0.01).Compared with before treatment,MAR was lower(P<0.05)and PER was higher(P<0.05)in the two groups after treatment,and MAR was lower(P<0.05)and PER was higher(P<0.05)in the study group compared with the control group.The main effect differences of IL-16 and IL-18 levels were statistically significant between time points and groups(P<0.01),and there were interactions between time points and groups(P<0.01).Compared with before treatment,the levels of IL-16 and IL-18 in the two groups were decreased after treatment(P<0.05),and the levels of IL-16 and IL-18 in the study group were lower than those in the control group(P<0.05).There were significant differences in the main effects of VEGF,IMT and plaque area between time points and groups(P<0.01),and there were interactions between time points and groups(P<0.01).Compared with before treatment,VEGF,IMT and plaque area in both groups were decreased after treatment(P<0.05),and VEGF,IMT and plaque area in the study group were lower than those in the control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the control group and the study group[0 vs 3.03%(2/66)](P>0.05).Conclusion Calcium dobesilate combined with short-term insulin intensive therapy is more beneficial to improving platelet function,reducing the level of inflammatory factors,delaying the degree of macrovascular disease in T2DM patients with macrovascular disease,with high safety.