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目的:观察罗格列酮联合胰岛素治疗2型糖尿病的疗效及安全性。方法:选择2007年7月至2008年7月间住院的2型糖尿病患者,共36例。入选前所有患者均连续接受门冬胰岛素30治疗4周以上,每日胰岛素用量在40u以上,空腹血糖(FPG)≥10.0mmol/l,餐后血糖(PPG)≥15.0mmol/l,糖化血红蛋白(HbAlc)≥8.0%,其中男性20例,女性16例,年龄32～65岁,病程5～20年。采用自身前后对照方法,所有36例患者在原有胰岛素治疗基础上均口服罗格列酮,每日最小剂量4mg,最大剂量12mg,疗程12周,检测全天7次血糖,调整胰岛素用量。治疗4周、8周、12周测FPG、PPG,治疗前后测HbAlc、谷丙转氨酶(ALT)、谷草转氨酶(AST)、尿素氮(BUN)、尿微量白蛋白(UAE)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL—c)、低密度脂蛋白胆固醇(LDL—c)、体质指数(BMI)。记录胰岛素(Ins)用量的变化。对上述结果进行统计分析。结果:治疗4周、8周、12周的FPG、PPG与治疗前比较均有下降(p<0.05)。治疗12周后HbAlc、TG有明显下降(p<0.01)。BMI、ALT、AST、BUN、UAE、HDL—c、LDL—c均无明显变化(p>0.05)。治疗前门冬胰岛素30用量为(48.7±9.58)u,治疗后用量为(33.4±8.96)u,明显减少,差异有统计学意义(p<0.01)结论:罗格列酮具有改善胰岛素抵抗,增加胰岛素敏感性,改善血脂的作用,与胰岛素联用可减少胰岛素用量,同时无肝肾不良反应,副作用少。
Objective: To observe the efficacy and safety of rosiglitazone combined with insulin in the treatment of type 2 diabetes mellitus. Methods: A total of 36 type 2 diabetic patients were selected from July 2007 to July 2008. All patients were treated with insulin aspart 30 for 4 weeks or more, daily insulin dosage was above 40u, fasting blood glucose (FPG) ≥10.0mmol / l, postprandial blood glucose (PPG) ≥15.0mmol / l, glycosylated hemoglobin HbAlc) ≥ 8.0%, of which 20 males and 16 females, aged 32 to 65 years, duration of 5 to 20 years. All 36 patients were given rosiglitazone on the basis of the original insulin therapy. The daily minimum dose was 4 mg and the maximum dose was 12 mg. The course of treatment was 12 weeks. Blood glucose was measured 7 times a day and insulin dosage was adjusted. The levels of FPG, PPG, HbAlc, ALT, BUN, UAE and triglyceride were measured before and after treatment for 4 weeks, 8 weeks and 12 weeks respectively. TG, HDL-c, LDL-c, and body mass index (BMI). Record changes in insulin dosage. Statistical analysis of the above results. Results: The FPG and PPG at 4 weeks, 8 weeks and 12 weeks after treatment decreased compared with those before treatment (p <0.05). After 12 weeks of treatment, HbA1c and TG were significantly decreased (p <0.01). BMI, ALT, AST, BUN, UAE, HDL-c, LDL-c had no significant change (p> 0.05). Before treatment, the dosage of Aspart 30 was (48.7 ± 9.58) u, the dosage was (33.4 ± 8.96) u after treatment, and the difference was statistically significant (p <0.01) Conclusion: Rosiglitazone can improve insulin resistance and increase Insulin sensitivity, improve blood lipids, combined with insulin can reduce the amount of insulin, while no adverse reactions of liver and kidney, fewer side effects.