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目的观察金芪降糖片联合吡格列酮对2型糖尿病(T2DM)患者胰岛素抵抗(IR)水平及胰岛素用量的研究,为T2DM的治疗提供依据。方法收集2014年5月至2015年5月就诊于天津医科大学代谢病医院,符合纳入及排除标准,病程在5年以内的T2DM患者118例,用随机数字表法将患者分为4组,A组(生活方式干预组)29例,B组(吡格列酮组)30例,C组(金芪降糖组))30例,D组(金芪降糖联合吡格列酮组)29例。4组均在原有治疗基础上给予相应的药物并调整胰岛素用量,每2周检测1次指血血糖,将空腹血糖(FPG)控制在6~8 mmol/L,餐后血糖(PPG)控制在8~10 mmol/L,6个月后比较4组治疗后体质指数(BMI)、糖化血红蛋白(Hb Al C)、FPG、空腹胰岛素(F-Ins)、胰岛素抵抗指数(HOMAIR)、全天胰岛素用量情况,用SPSS 22.0软件对计数资料进行χ2检验,计量资料多组间比较用单因素方差分析。结果治疗前后4组BMI、Hb A1C、FPG比较,差异均无统计学意义(P>0.05)。治疗前4组间F-Ins比较,差异无统计学意义(P>0.05);治疗后4组间比较,差异有统计学意义(F=27.727,P<0.01),A组F-Ins[(21.00±5.14)m IU/L]高于其他3组[分别为(13.59±4.33)、(14.68±3.56)和(11.08±4.11)m IU/L],D组F-Ins低于B、C组,差异均有统计学意义(P<0.05,P<0.01),B、C组间比较,差异无统计学意义(P>0.05)。4组间治疗前HOMA-IR比较,差异无统计学意义(P>0.05);治疗后4组间比较,差异有统计学意义(F=26.331,P<0.01),A组HOMA-IR(6.55±1.84)高于其他3组(分别为4.11±1.32、4.49±1.09和3.41±1.32),D组HOMA-IR低于C组,差异均有统计学意义(P<0.05),B组与C、D组间比较,差异均无统计学意义(P>0.05)。4组间治疗前胰岛素用量比较,差异无统计学意义(P>0.05);治疗后4组间胰岛素用量比较,差异有统计学意义(F=23.103,P<0.01),A组胰岛素用量[(37.52±4.34)IU]多于其他3组[分别为(25.10±5.13)、(29.23±3.15)和(21.31±4.25)IU],D组胰岛素用量低于B、C组,B组胰岛素用量低于C组,差异均有统计学意义(P<0.01)。结论金芪降糖与吡格列酮都可改善T2DM患者的IR,减少全天胰岛素用量,两药合用优于单一用药。
Objective To observe the effects of Jinqi Hypoglycemic Tablets combined with pioglitazone on insulin resistance (IR) and insulin dosage in patients with type 2 diabetes mellitus (T2DM), and to provide basis for the treatment of T2DM. Methods A total of 118 T2DM patients were enrolled in the Metabolic Hospital of Tianjin Medical University from May 2014 to May 2015 and were eligible for inclusion and exclusion. The patients were divided into 4 groups with random number table 29 patients in the intervention group (lifestyle intervention group), 30 patients in the group B (pioglitazone group), 30 patients in the group C (Jinqi hypoglycemic group), and 29 patients in the group D (hypoglycemic and pioglitazone group). The patients in the four groups were given the corresponding drugs on the basis of the original treatment and the amount of insulin was adjusted. The blood glucose was measured every two weeks, the fasting blood glucose (FPG) was controlled at 6 ~ 8 mmol / L and the postprandial blood glucose (PPG) (BMI), HbAc, FPG, F-Ins, HOMAIR, insulin all day were measured after 8 to 10 mmol / L for 6 months. The amount of use of SPSS 22.0 software to count data for χ2 test, measurement data were compared between groups using one-way analysis of variance. Results There was no significant difference in BMI, Hb A1C and FPG between the four groups before and after treatment (P> 0.05). There was no significant difference in F-Ins between the four groups before treatment (P> 0.05). After treatment, the difference between the four groups was statistically significant (F = 27.727, P <0.01) 21.00 ± 5.14) m IU / L] were higher than the other three groups [(13.59 ± 4.33), (14.68 ± 3.56) and (11.08 ± 4.11) m IU / L] (P <0.05, P <0.01). There was no significant difference between B and C groups (P> 0.05). There was no significant difference in HOMA-IR between the four groups before treatment (P> 0.05). There was significant difference between the four groups after treatment (F = 26.331, P <0.01) ± 1.84) were higher than those in the other three groups (4.11 ± 1.32, 4.49 ± 1.09 and 3.41 ± 1.32, respectively). The HOMA-IR in group D was lower than that in group C (P <0.05) There was no significant difference between D group (P> 0.05). There was no significant difference in the amount of insulin before treatment between the four groups (P> 0.05), but the difference was statistically significant (F = 23.103, P <0.01) 37.52 ± 4.34 IU) were more than those in the other three groups (25.10 ± 5.13, 29.23 ± 3.15, and (21.31 ± 4.25) IU, respectively). The insulin dosage in group D was lower than that in group B and C In group C, the differences were statistically significant (P <0.01). Conclusion Both HDG and pioglitazone can improve the IR of T2DM patients and reduce the dosage of insulin in the whole day. The combination of two drugs is better than single drug.