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目的研究罗格列酮及瑞格列奈单药治疗对新诊断2型糖尿病患者急性相胰岛素分泌功能(AIR)的影响。方法筛选2001—2004年上海10家市级医院内分泌代谢科206例新诊断的2型糖尿病患者,年龄30～70岁。根据精氨酸刺激试验分为AIR正常组及AIR低下组,再进一步随机进入罗格列酮单药治疗亚组与瑞格列奈单药治疗亚组,每12周随访一次,总观察期限为48周。结果治疗后各亚组的血糖(PG)、糖化血红蛋白(HbA1c)均较基线时明显降低(P<0.05)。157例完成随访者研究结束时HbA1c达标率(<6.5%)为63.0%。AIR正常组中,罗格列酮亚组的胰岛素原(PI)、PI/真胰岛素(TI)降低(P<0.01),瑞格列奈亚组的TI显著增高(P<0.05)。AIR低下组中,罗格列酮亚组的PI、PI/TI及胰岛素抵抗指数(HOMA-IR)明显降低(P<0.05),而精氨酸刺激的ΔTI/PG及其曲线下面积(AUC)明显增加(P<0.01)。瑞格列奈亚组TI及AUC升高(P<0.01),但PI/TI下降(P<0.05)。结论罗格列酮能改善2型糖尿病患者的AIR。
Objective To study the effects of rosiglitazone and repaglinide on the acute phase insulin secretion (AIR) in newly diagnosed type 2 diabetic patients. Methods A total of 206 newly diagnosed type 2 diabetic patients aged 30-70 years in the Endocrinology and Metabolism Section of 10 municipal hospitals in Shanghai from 2001 to 2004 were screened. According to the arginine stimulation test divided into AIR normal group and AIR low group, and then further randomized into rosiglitazone monotherapy subgroup and repaglinide monotherapy subgroup, followed up every 12 weeks, the total observation period 48 weeks. Results After treatment, the levels of blood glucose (PG) and glycosylated hemoglobin (HbA1c) in each subgroup were significantly lower than those at baseline (P <0.05). The compliance rate of HbA1c (<6.5%) was 63.0% at the end of 157 patients who completed the study. In the normal AIR group, the proinsulin (PI) and PI / true insulin (TI) in rosiglitazone subgroup decreased (P <0.01), and the TI in repaglinide group increased significantly (P <0.05). In the AIR-low group, the PI, PI / TI and HOMA-IR of rosiglitazone subgroups were significantly decreased (P <0.05), whereas arginine-stimulated ΔTI / PG and its area under the curve ) Increased significantly (P <0.01). The TI and AUC in repaglinide group were higher (P <0.01), but PI / TI was decreased (P <0.05). Conclusion Rosiglitazone can improve AIR in type 2 diabetic patients.