高建苑捷诺维强效降糖高建苑—培训课件.pptVIP

36名2型糖尿病患者RCT,cross-over 研究。 这是在加拿大做的一个36名2型糖尿病患者双盲的,cross-over 研究（30位男性及6位绝经后妇女）。患者在随机化前已经口服稳定剂量的二甲双胍超过3月，患者入组前HbA1C/=8.5%,且入组前6周未服用过其他口服降糖药物，进入1周的观察期及4周的安慰剂导入期后进入实验。患者先进入6周按随机分配口服西格列汀或安慰剂，然后经过4周的洗脱期后，在进入6周的交叉实验。完成每个6周的的最后一天空腹12小时后抽血，完成空腹血脂的测定，后口服实验餐后每2、4、6、8小时测定血脂等指标的变化。因此左图提示的是6周后空腹状态下口服西格列汀组与安慰剂组相比，血脂等指标的变化，可见经过6周后西格列汀组在空腹状态下已经能降低胆固醇、载脂蛋白、低密度脂蛋白。而右图提示的是餐后2、4、6、8小时后测定西格列汀组及安慰剂组血脂指标变化的曲线下面积，可见西格列汀能明显降低餐后胆固醇、载脂蛋白、游离脂肪酸、极低密度脂蛋白。 * Slide 30 :对象：日本17位2型糖尿病人（8男9女），血糖控制不佳（日本的标准是HbA1C6%），伴有血压增高。入组前6个月内血压无明显变化或未改变过其口服的降压药物。高血压的定义为收缩压130,舒张压80.患者在实验前已经口服的降糖药物（如二甲双胍、比格列酮、格列奈类、磺脲类及a葡萄糖苷酶抑制剂）及口服的降血压药物（钙通道阻滞剂、利尿剂）等将不改变剂量继续使用，同时每天早餐后服用西格列汀50mg，观察6个月。患者平均年龄67.1，平均糖尿病病程13.2年，BG 130.0mg/dl,HbA1c 6.5+/-0.3%，SBP 130.4+/-13.9mmHg,DBP 71.2+/-5.6mmHg.用药6个月后HbA1c 5.8+/-0.3%, SBP 119.7+/-9.4mmHg,DBP 基本不变。 * * * Background/Aims: Recently, high serum DPP-4 activity was found in patients with NAFLD. Therefore, the possibility of NAFLD adversely influencing the therapeutic effect afforded by DPP-4 inhibitors in type 2 diabetic patients was suggested. Methodology: A total of 20 type 2 DM patients with NAFLD and 85 type 2 DM patients without NAFLD were enrolled in the present study. The patients were administered sitagliptin at the dose of 50 mg/day for 12 weeks. Results: The change in HbA1c from the baseline following treatment with sitagliptin was -0.47% (4 weeks), -0.73% (8 weeks) and -0.88% (12 weeks) in the type 2 DM patients with NAFLD and -0.26% (4 weeks), -0.41% (8 weeks) and -0.49% (12 weeks) in type 2 DM without NAFLD. The changes in the HbA1c from the baseline after sitagliptin treatment for 8 and 12 weeks were significantly greater in type 2 DM patients with NAFLD than in type 2 DM patients without NAFLD. Conclusions: The results of this study suggest that NAFLD might adversely affect the therapeutic effect afforded by sitagliptin treatment in patients with type 2 DM. NAFLD may be an independent predictor of the effect of sitagliptin in patients with type 2 DM. Left: The changes o