目的探討預混胰島素治療的2型糖尿病患者轉為基礎胰島素聯(lián)合口服降糖藥的有效性與安全性。 方法選取2010年2月－2011年8月就診的36例使用預混胰島素2次/d，穩(wěn)定劑量治療12周以上，糖化血紅蛋白≤10%的門診2型糖尿病患者。將治療藥物轉為基礎胰島素加口服降糖藥物，隨訪治療24周，觀察分析患者的體質量，空腹、餐后血糖，糖化血紅蛋白，低血糖事件及胰島素劑量變化。 結果36例患者完成研究。甘精胰島素治療后患者的體質量較治療前下降[（63.77±10.34）、（62.31±9.98）kg，P=0.002]，胰島素總量較前有明顯下降[（23.56±6.15）、（10.28±4.04）U/d，P=0.000]。預混胰島素治療糖化血紅蛋白≤7%的亞組，經甘精胰島素治療后糖化血紅蛋白有進一步的下降[（6.70±0.81）%、（6.34±0.55）%，P=0.007]，胰島素的劑量為（0.16±0.06）U/（kg·d），低血糖事件與非達標組相比差異無統(tǒng)計學意義（33.33%、55.56%，P=0.267）。與預混胰島素相比，會增加1～2種口服藥的聯(lián)合使用，使用最多的為二甲雙胍（17/36）。 結論糖化血紅蛋白≤7%的預混胰島素治療患者，換用甘精胰島素聯(lián)合口服降糖藥物治療，在獲得良好的血糖控制的同時，也具有良好的安全性和其他綜合療效。
【摘要】 目的 觀察羅格列酮加二甲雙胍聯(lián)合治療對2型糖尿病患者的降糖作用和安全性以及對胰島素抵抗的影響。 方法 對2007年8月-2008年5月收治的2型糖尿病患者53例采用自身前后對照研究，48例符合入選條件的患者，接受羅格列酮加二甲雙胍為期12周治療。試驗開始和結束日測定患者空腹血糖（fast plasma glucose，F(xiàn)PG）、血清胰島素（serum insulin，F(xiàn)INS）、總膽固醇（total cholesterol，TC）、甘油三酯（triglyceride，TG）、高密度脂蛋白膽固醇（high-density lipoprotein cholesterol，HDL-C）和糖化血紅蛋白（glycosylated hemoblobin，HbA1c）以及標準餐后2 h血糖（postprandial 2 hours blood glucose，2hPPG）和胰島素（postprandial 2 hours insulin，2hPINS）。胰島素敏感性采用HOMA2模型公式評價。 結果 12周時FPG、FINS、2hPINS、 HbA1c均較治療前基線時下降，分別為（8.16±2.37） mmol/L與（6.57±1.90） mmol/L，（8.84±8.07） mU/L與（7.28±6.84） mU/L，（26.87±3.13） mU/L與（20.18±13.25） mU/L，7.60%±1.71%與6.79%±1.82%，差異有統(tǒng)計學意義（Plt;0.05）。胰島素抵抗指數(shù)顯著低于治療前（2.77±0.90與3.74±1.61，Plt;0.05）。其余代謝參數(shù)變化差異無統(tǒng)計學意義（Pgt;0.05）。 結論 羅格列酮加雙胍類藥物聯(lián)合治療2型糖尿病能有效降2型糖尿病患者的血糖水平，提高胰島素敏感性，不增加體重，無低血糖發(fā)生，是一種安全有效的治療方案。【Abstract】 Objective To observe the effect and security of rosiglitazone plus metformin in patients with type 2 diabetes mellitus, and the effect on insulin resistance. Methods Forty-eight cases suitable for this study were accepted and compared from August 2007 to May 2008. Patients accepted rosiglitazone plus metformin for 12 weeks. Fasting plasma glucose (FPG), serum insulin (FINS), total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), glycosylated hemoglobin (HbA1c), postprandial 2 hours blood glucose and postprandial 2 hours insulin were determined at the first and last day of this study. HOMA 2 model formula evaluation was used in testing insulin sensitivity. Results After a 12-weeks’ treatment, FPG, FINS, 2hPINS, and HbA1c of patients were lower than those before treatment [(8.16±2.37) mmol/L vs (6.57±1.90) mmol/L; (8.84±8.07) mU/L vs (7.28±6.84) mU/L; (26.87±19.31) mU/L vs (20.18±13.25) mU/L; 7.60%±1.71% vs 6.79%±1.82%; Plt;0.05)]. Insulin resistance index was lower than that after treatment (2.77±0.90 vs 3.74±1.61, Plt;0.05). Other metabolic related parameter had no statistical difference (Pgt;0.05). Conclusion Rosiglitazone plus metformin treatment of type 2 diabetes mellitus is effective both in reducing in blood glucose levels and improving insulin sensitivity, and without gain weight, incidence of hypoglycemia. It is a safe and effective option.
【摘要】 目的 觀察重組人甲狀旁腺激素（1-34）[rhPTH（1-34）]治療骨質疏松癥患者骨密度的療效和安全性。 方法 采用自身前后對照臨床研究，納入2008年3-5月就診的原發(fā)性骨質疏松癥患者共39例，予rhPTH（1-34） 20 μg 1次/d皮下注射，療程18個月。治療期間均同時口服鈣制劑600 mg/d及維生素D3 125 U/d作為基礎治療。患者治療前采用雙能X線檢測腰2~4椎體（L2~4）和股骨頸骨密度（BMD）、肝腎功能、血鈣、血磷，治療后6、12、18個月復查BMD和上述生化指標改變，記錄患者不良事件，對患者治療前后L2~4、股骨頸BMD變化進行對比分析。 結果 35例患者完成全療程治療，其中男2例，女33例；平均年齡65歲，平均病程6.5年；治療6、12、18個月時L2~4 BMD均較治療前明顯提高（Plt;0.01），而股骨頸BMD在治療6、12個月時改善不明顯（Pgt;0.05），18個月時表現(xiàn)出較治療前明顯增加（Plt;0.01）；腰椎平均BMD增長率為12.27%，股骨頸BMD增長率為4.11%；治療期間不良反應少，均不需特殊處理而自行好轉。 結論 rhPTH（1-34）治療原發(fā)性骨質疏松癥安全有效，對改善椎體BMD療效迅速明顯，對改善股骨頸BMD起效慢；適用于絕經后骨質疏松和老年性骨質疏松癥患者。【Abstract】 Objective To observe the therapeutic effect of recombinant human parathyroid hormone (1-34) [rhPTH(1-34)] on the improvement of bone mineral density (BMD) in patients with primary osteoporosis. Methods A before and after self control study was performed on 39 patients with primary osteoporosis from March to May 2008. The patients underwent the subcutaneous injection with rhPTH (1-34) 20 μg/d for 18 months. All patients were given oral calcium (Ca 600 mg+Vit D3 125 U per day) as primary drug treatment. BMD of lumbar spine (L2-L4) and femur neck, serum calcium, and serum phosphate were measured before and 6, 12, and 18 months after the treatment. All of the adverse reactions were recorded. Results A total of 35 patients finished the trial,including two males and 33 females with the average age of 65 years and the course of disease of (6.54±4.30) years. BMD of lumbar spine (L2-L4) significantly increased 6, 12, and 18 months after treatment (Plt;0.01). There was no significant difference of femur neck BMD 6 and 12 months after treatment (Pgt;0.05), whereas by the end of the treatment, it improved significantly (Plt;0.01). The average increase rate was 12.27% in lumbar spine (L2-L4) and was 4.11% in femur neck BMD. There were a few adverse reactions during the therapeutic process, most of which were tolerable and self-restored. Conclusion rhPTH(1-34) is an effective and safe drug in treating primary osteoporosis. It can increase lumbar spine BMD rapidly and raise femur neck BMD gradually. It is applicable for postmenopausal osteoporosis and senile osteoporosis.