二甲双胍联合吡格列酮治疗初发肥胖2型糖尿病疗效观察.docVIP

二甲双胍联合吡格列酮治疗初发肥胖2型糖尿病疗效观察 　 作者：乔静，周瑞秀，马晓莉，荆爱玲，孙述栋，闫方明，谢永平 【摘要】 目的 观察二甲双胍联合吡格列酮对初发肥胖2型糖尿病（T2DM）患者降糖、降脂的临床疗效及对胰岛素抵抗、体重指数、腰臀比的影响。方法 选择初发肥胖2型糖尿病(T2DM)患者320例，随机分为两组：二甲双胍联合吡格列酮162例作为治疗组，给予盐酸二甲双胍500mg，每天2次，吡格列酮片30mg，每天1次；单用二甲双胍158例作为对照组：给予盐酸二甲双胍500mg，每天2次。两组疗程均为12周。两组治疗前后观察体重指数、腰臀比的变化，测定空腹血糖、餐后2h血糖、血脂、空腹胰岛素、糖化血红蛋白(HbA1c)，计算胰岛素抵抗指数(HOMA-IR)。结果 （1）两组在治疗后空腹血糖（FPG）、餐后2h血糖（2hPG）和糖化血红蛋白（HbA1c）较用药前明显降低。治疗组血糖控制达标率为89.6%，对照组达标率为63.5%，治疗组显著高于对照组(P＜0.05)。（2）治疗组HOMA-IR较治疗前显著改善，明显优于对照组，两组治疗后BMI和WHR均较用药前降低，但两组之间差异无显著性。（3）两组治疗后血清甘油三酯、胆固醇、低密度脂蛋白胆固醇均显著降低，而高密度脂蛋白胆固醇明显升高。结论 二甲双胍联合吡格列酮可以显著降低初发肥胖2型糖尿病血糖、血脂水平；可明显改善初发肥胖2型糖尿病胰岛素抵抗状态，改善胰岛素敏感性，降低体重指数及腰臀比，从而更利于血糖、血脂代谢紊乱的控制。二甲双胍联合吡格列酮治疗，可作为初发肥胖2型糖尿病患者首选的治疗方法。 【关键词】 2型糖尿病；二甲双胍；吡格列酮；胰岛素抵抗；肥胖症 Clinical observation of metformin combined with pioglitazone in treating newly diagnosed obesity type 2 diabetes patients 【Abstract】 Objective To observe the therapeutic effect of metformin combined with pioglitazone on glycemia, lipidemia, insulin resistance, BMI and WHR in patients with newly diagnosed obesity type 2 diabetes. Methods 320 patients with newly diagnosed obesity type 2 diabetes were randomly divided into two groups. 160 patients in the treatment group were treated by metformin (500mg twice daily) and pioglitamne (30mg once daily). 158 patients in the control group were given metformin (500mg twice daily). The treatment course lasted for 12 weeks. The levels of fasting plasma glucose (FPG), 2 hour postprandial plasma glucose (2hPG), HbAlc, serum lipids, fasting insulin, BMI and WHR were determined before and after the treatment in two groups. Then insulin resistance index was estimated by the insulin resistance index of homeostasis model assessment (HOMA-IR). Results After treatment the levels of FPG, 2hPG, HbAlc, FINS and P2hlNS were decreased significantly in two groups. The blood glucose well controlling rates were 89.6% and 63.5% in the treatment and control groups respectively. The blood glucose well controlling ratio of treatment group was s