摘要
目的 2型糖尿病患者体内存在氧化应激状态,明显高于正常人,糖尿病并发症的发生氧化应激此密切相关。文中分析甘精胰岛素注射剂和瑞格列奈(repaglinide)片治疗作用的特点,探讨不同干预治疗对2型糖尿病患者血丙二醛(ma-londialdehyde,MDA)及超敏C反应蛋白(high-sensitivity C-reactive protein,hs-CRP)水平的影响。方法应用二甲双胍治疗的2型糖尿病患者,随机分为甘精胰岛素和瑞格列奈治疗2组,每组有效病例数为33例。选择性别、年龄、体质指数(bodymass index,BMI)等一般情况相匹配的健康体检者26例作为对照组。观察治疗前后糖化血红蛋白(glycated hemoglobin A1c,HbA1c)、BMI、血MDA和hs-CRP、空腹血糖(fasting blood glucose,FBG)及餐后血糖(postprandial blood glucose,PBG)、三酰甘油(triglyceride,TG)、总胆固醇(total cholesterol,TC)、血糖波动等相关指标的变化。结果①治疗前,甘精胰岛素组和瑞格列奈组患者TG、FBG、PBG、HbAlc、BMI和MDA等指标2组间无明显差异均(P>0.05)。②甘精胰岛素组和瑞格列奈组治疗后HbA1c、MDA、hs-CRP水平明显降低,与治疗前相比差异有统计学意义(P<0.01)。③治疗后甘精胰岛素组FBG和TG水平降低,与治疗前相比差异有统计学意义(P<0.01、P<0.05);治疗后瑞格列奈组PBG水平降低,与治疗前相比较差异有统计学意义(P<0.05);④与对照组相比,甘精胰岛素组和瑞格列奈组治疗后hs-CRP和MDA水平仍较高,差异有统计学意义(P<0.05);治疗后甘精胰岛素组和瑞格列奈组2组间MDA水平差异无统计学意义(P>0.05)。⑤治疗后甘精胰岛素组hs-CRP水平低于瑞格列奈组,差异有统计学意义(P<0.05)。⑥甘精胰岛素组血糖波动幅度较小,与瑞格列奈组相比,差异有统计学意义(t=4.003,P<0.01)。⑦MDA水平与FBG、PBG、HbA1c、胰岛素用量呈正相关(r=0.229,P=0.019;r=0.371,P=0.002;r=0.265,P=0.028;r=0.405,P=0.021)。结论 2型糖尿病患者体内存在明显的氧化应激状态。应用甘精胰岛素治疗可减轻其体内的氧化应激水平。甘精胰岛素治疗效果与瑞格列奈相比无差异。甘精胰岛素能更好的控制FBG且降低血糖波动幅度,能更有效地降低TG和hs-CRP。瑞格列奈具有更强的降低PBG作用。甘精胰岛素不仅可降低血糖,还具有抗炎、降血脂、抗氧化应激的作用。血糖水平、血糖波动幅度及胰岛素用量可反映体内氧化应激程度。
Objective Diabetes with hyperglycemia can produce more oxidative products,which is closely associated with diabetic complications.We explored the effect of glargine in the development of chronic complications of type 2 diabetes by detecting the levels of malondialdehyde（MDA） and high-sensitivity C-reactive protein（hs-CRP） in type 2 diabetic patients treated with glargine.Methods Sixty-six diabetic patients whose blood glucoses were not well controlled by metformin were randomly assigned to receive glargine and metformin（Group A,n=33） or repaglinide and metformin（Group B,n=33）.Meanwhile,another 26 healthy subjects were selected as normal controls（Group C）,who matched the included patients in gender,age and body mass indexes（BMI）.The relevant indexes were observed and compared before and after the treatment,including glycosylated hemoglobin（HbAlc）,BMI,malondialdehyde（MDA）,and hs-CRP,fasting plasma glucose（FPG）,postprandial blood sugar（PBG）,triglyceride（TG）,and total cholesterol（TC）.Results There were no significant differences in TG,FBG,PBG,HbAlc,BMI and MDA between Groups A and B before the treatment（P0.05）.After the treatment,the levels of MDA and hs-CRP in these two groups were significantly lower than before（P0.01）;the levels of FBG and TG were markedly lower,while that of PBG obviously higher in Group A than in B（P0.05）;the concentrations of hs-CRP and MDA were remarkably higher in both A and B than in C（P0.05）,but with no significant difference in the level of MDA between A and B（P0.05）;and the level of hs-CRP was significantly lower in A than in B（P0.05）.The fluctuation of blood glucose in the course of treatment was significantly lower in Group A than in B（t=4.003,P0.01）.The MDA level was positively correlated with FBG（r=0.229,P=0.019）,PBG（r=0.371,P=0.002）,HbAlc（r=0.265,P=0.028） and the dose of insulin（r=0.405,P=0.021）.Conclusion Glargine insulin can reduce oxidative stress in type 2 diabetic patients,with similar therapeutic effect to that of repaglinide.It not only decreases blood glucose and blood fat,but also has anti-inflammatory and anti-oxidative stress effects.The degree of oxidative stress in type 2 diabetic patients appears to be closely associated with the level and fluctuation of blood sugar and the dose of insulin.
出处
《医学研究生学报》
CAS
2011年第1期49-54,共6页
Journal of Medical Postgraduates
基金
南京市医学科技发展项目(ZKM06036)
关键词
甘精胰岛素
瑞格列奈
2型糖尿病
氧化应激
丙二醛
超敏C反应蛋白
慢性并发症
Glargine insulin
Repaglinide
Type 2 diabetes mellitus
Oxidative stress
Malondialdehyde
High-sensitivity C-reactive protein
Chronic complication
作者简介
张颖（医学硕士研究生）
通讯作者：马建华，E—mail：majianhua@china．com.
