格列美脲与罗格列酮对2型糖尿病中老年人患者胰岛素抵抗胰岛β细胞功能游离脂肪酸影响.docVIP

格列美脲与罗格列酮对2型糖尿病中老年人患者胰岛素抵抗胰岛β细胞功能游离脂肪酸影响 　　【中图分类号】R587.1 【文献标识码】A【文章编号】1005-2720(2010)09 - 16 - 03 　　【摘要】目的 探讨应用格列美脲与罗格列酮药物对2型糖尿病中老年人患者的胰岛β细胞功能及胰岛素抵抗,血FAA的影响。方法 141名2型糖尿病中老年人患者分为格列美脲与罗格列酮治疗组,测定治疗前后空腹血糖(FPG),空腹游离脂肪酸(FFA),免疫反应胰岛素(IRI)、真胰岛素(SI)、胰岛素原(PI)水平,计算PI占总胰岛素比例,并比较治疗前后HOMA模型中胰岛素抵抗指数(HOMA-IR)及β细胞功能指数(HOMA-IS)的变化,分析血糖下降对胰岛素抵抗。结果 (1)两治疗组FPG、HbAIC均较治疗前有显著下降,两组间比较差异无显著性。(2)治疗后两组HOMA-IS均有较明显上升,格列美脲组上升72%;罗格列酮组上升57%,但两组间比较差异无显著性。两组HOMA-IR治疗后较治疗前均下降,格列美脲组下降15%;罗格列酮组下降32%,两组间比较有显著性异(P0.05)。(3)格列美脲与罗格列酮两治疗组与治疗前血清游离脂肪酸(FAA)均有较显著下降,分别为(P0.01、P0.001),两治疗组间比较,罗格列酮组血FAA比格列美脲组为低,有显著差异(P0.01)。治疗后服格列美脲者空腹PI及SI水平均略有下降,但无统计学差异;服罗格列酮者空腹血清PI及SI水平均略有上升,亦无统计学差异。结论 应用HOMA模型计算,服用格列美脲及罗格列酮的患者HOMA-IS均有显著上升,HOMA-IR显著下降,都具有改善胰岛素抵抗和胰岛β细胞功能分泌功能,有较好胰外作用和降低血清FAA作用。因二者药理作用机制不同,格列美脲在改善患者β细胞胰岛素分泌功能比罗格列酮好,但罗格列酮在改善患者胰岛素抵抗、降低血FAA优于格列美脲。 　　【关键词】中老年人;胰岛;β细胞功能;胰岛素抵抗;血游离脂肪酸;胰岛素原;真胰岛素 　　The effects Glimepiride andRosiglitazone on insuline resistance, isletβ-cell function and FAA in the middle-aged, Patients oatients with type 2 diabetes 　　Xia De Wu 　　(Department ofEndocrinalogy .The Third hosoital ofYong Zhou Hu Nan,Hu Nan YongZhou425000) 　　【Abstract】Objective To investigatre the effects ofhypoglycenin drug shulfonylareas ,extended-release Glimepiride and Rosiglitazone on insulinresistance, islct β-cell function and blood FAA the middle-aged patientsin patiehts with type 2 diabetes.Methods one hundred and forty-one the middle-aded patients diabenes were divided into Glimepiride and Rosiglitazone group. Fasting Plasma glucose(FPC). Free fatty acid (FFA) Fastingserum immuno-reactiveiusulin[IRI] , Specificinsplin [SI] andproinsulin(P1) lerels wcre measured before and aftertreatment, proportion ofPI Was caculated. The correbation between the amelicration of insulinresistanceandchangersof blood glucose levcls was analysed by HOMAmodel,insulin resistanceindex(HOMA-IR) and β-cellfunction index(HOMA-IS). Results (1)FPG andHbAIC was significantly decreasedintwo groups, there was no significant difference bet