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目的探讨不同种类口服降糖药联用对2型糖尿病患者动脉内膜中层厚度(intima-media thick-ness,IMT)和斑块发生率的影响。方法选取初发2型糖尿病患者139例(2002年),将患者分为一种、两种、三种口服降糖药物单用组(SING、DOUB、TRIP)和不使用口服降糖药物组(NONE)及对照组。对比分析随访第6年(07年)和第8年(09年)各组颈动脉、髂动脉及股动脉的IMT值与斑块发生率以及其他临床指标的变化情况。结果 (1)TRIP组09年胰岛素(insulin,INS)水平与07相比略有降低。(2)TRIP组09年动脉IMT与07年相比有下降趋势,而对照组动脉IMT值显著升高(P<0.05)。(3)TRIP组的动脉斑块发生率低于同期其他各组对应的动脉斑块发生率(P<0.05)。(4)口服降糖药物联用种类与动脉斑块发生率具有明显相关性(P<0.05)。(5)本研究证明INS是颈动脉斑块发生的危险因子(P<0.05),餐后2 h血糖(2hPG)和INS为髂动脉斑块发生的危险因子(P<0.05)。结论罗格列酮+二甲双胍+格列吡嗪三种口服降糖药联用的三联疗法能控制胰岛素升高,延缓甚至逆转脉内膜增厚进程并且能够抑制动脉斑块发生,是较全面的防治2型糖尿病大血管病变的综合疗法。
Objective To investigate the effects of different oral hypoglycemic agents on intima-media thick-ness (IMT) and plaque incidence in type 2 diabetic patients. Methods A total of 139 patients with newly diagnosed type 2 diabetes mellitus (2002) were enrolled. Patients were divided into one, two and three oral administration groups (SING, DOUB, TRIP) and no oral hypoglycemic group NONE) and control group. The changes of IMT, plaque incidence and other clinical indexes of carotid artery, iliac artery and femoral artery in the 6th (07th) and 8th (09th) years follow-up were compared. Results (1) The level of insulin (INS) in TRIP group was slightly lower than that in 07. (2) The IMT of arterial IMT decreased in 2009 in TRIP group compared with that in 2007, while the IMT of arterial in control group increased significantly (P <0.05). (3) The incidence of atherosclerotic plaques in TRIP group was lower than that of other groups in the same period (P <0.05). (4) The combination of oral hypoglycemic agents and the incidence of atherosclerotic plaques have obvious correlation (P <0.05). (5) The present study demonstrated that INS is a risk factor for carotid plaque (P <0.05), and 2 h postprandial blood glucose (2 hPG) and INS are risk factors for the development of iliac artery plaque (P <0.05). Conclusions Triple therapy of rosiglitazone + metformin + glipizide combined with oral hypoglycemic agents can control the increase of insulin, delay or even reverse the course of intima thickening and inhibit the development of arterial plaque, which is more comprehensive Prevention and treatment of type 2 diabetes macrovascular disease combined therapy.