罗格列酮与胰岛素合用对LADA患者胰岛β细胞功能保护作用的初步观察

Rosiglitazone combined with insulin preserves islet β cell function in LADA:A preliminary study

目的 探讨罗格列酮 (Rosiglitazone,RSG)与胰岛素 (Ins)合用对成人隐匿性自身免疫糖尿病 (L ADA)患者胰岛β细胞功能的影响。 方法 对临床初诊为 2型糖尿病 (T2 DM)患者进行谷氨酸脱羧酶抗体 (GADA )检测 ,筛选出 GADA阳性、空腹 C肽≥ 30 0 pm ol/ L的 L ADA患者 1 2例 ,随机分为 Ins组 (n=6 )、Ins+RSG组 (合用组 ) (n=6 )。分别在入组时和入组后 1 2个月检测空腹血糖、C肽、糖化血红蛋白 (Hb A1 c)、75 g葡萄糖负荷后 2 h血糖和 C肽 ,进行胰岛功能的比较。用放射配体法检测 GADA水平 ,放免法检测 C肽。 结果 随访 1年时 Ins+RSG组的糖负荷后 2 h C肽高于 Ins组 (1 6 95 .0 pmol/ L对 782 .1 pmol/ L ,P<0 .0 5 ) ;Ins组随访 1年前后的 C肽有下降趋势 (从 1 71 0 .5pmol/ L到 782 .1 pm ol/ L ) ,而 Ins+RSG组变化不明显 (从 1 2 4 2 .9pm ol/ L到 1 6 95 .0 pm ol/ L ) ,合用组治疗前后糖负荷后 C肽的差值 (治疗后 -治疗前 )较单用 Ins组为高 (2 4 3.0 pm ol/ L - 1 0 79.6pmol/ L ,P<0 .0 5 )。逐步回归分析显示 :入组时的餐后 2 h C肽、体质指数 (BMI)、Ins和 RSG联合治疗与随访 1年时的糖负荷后 C肽水平呈正相关 ,其中以最后一个因素的标准回归系数为大 (分别为0 .3、1 37.2、76 7.1 ;P值分?

Objective To investigate the effect of rosiglitazone and insulin on islet β cell function in latent autoimmune diabetes in adults (LADA). Methods Glutamic acid decarboxylase (GAD) antibody was screened in patients initially diagnosed type 2 diabetes. LADA patients, defined as positive GAD antibody and with a fasting C peptide of 300 pmol/L or more, were selected and randomly assigned to receive subcutaneous insulin alone ( n =6) or rosiglitazone combined with insulin ( n =6) to compare the changes of islet β cell function. At entry and 1 year after treatment, blood was drawn to determine plasma glucose, HbA 1c and C peptide at fasting and 2 hours after taking 75 g glucose without medication. GAD antibody and C peptide were measured with radioligand immunoassay and radioimmune assay respectively. Results After 1 year treatment, LADA patients in rosiglitazone and insulin group had a higher postprandial C peptide than those in subcutaneous insulin group(782.1 pmol/L vs 1 695.0 pmol/L, P <0.05). During 1 year observation, C peptide levels in patients treated with insulin alone had a tendency to decline (from 1 710.5 pmol/L to 782.1 pmol/L) while that of the rosiglitazone combined with insulin group stayed steady (from 1 242.9 pmol/L to 1 695.0 pmol/L). The difference of postprandial C peptide before and after 1 year treatment(post treatment subtract pre treatment) was significantly bigger in combined treated group than that of insulin alone group (243.0 pmol/L vs 1 079.6 pmol/L, P <0.05). The linear stepwise regression analysis showed that postprandial C peptide level and body mass index (BMI) at entry, different treatment regime were positively correlated with postprandial C peptide after 1 year, of which the last factor played a key role. No severe side effects were observed in both groups. Conclusion Rosiglitazone combined with insulin may help preserve β cell function in LADA patients.