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作者	单位	E-mail
陈红霞	北京市第一中西医结合医院内分泌科北京100000	linchuangyx2018@163.com
史婷婷	首都医科大学附属北京同仁医院内分泌科北京100000
袁群	北京市第一中西医结合医院内分泌科北京100000
马丽荣	北京市第一中西医结合医院内分泌科北京100000
杨金奎	首都医科大学附属北京同仁医院内分泌科北京100000
李瑞杰	北京市第一中西医结合医院内分泌科北京100000

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中文摘要:

摘要目的：探讨吡格列酮联合阿卡波糖治疗2型糖尿病的临床效果及对患者血清视黄醇结合蛋白4(RBP4)、瘦素(Leptin)、内脂素(Visfatin)表达的影响。方法：选择2015年10月至2017年10月我院接诊的90例2型糖尿病患者为本研究对象，通过随机数表法将其分为观察组(n=46)和对照组(n=44)。对照组在常规治疗基础上给予阿卡波糖治疗，观察组在对照组基础上联合吡格列酮治疗，两组均连续治疗12周。比较两组治疗前后血糖、动态血糖、胰岛细胞功能、血清RBP4、Leptin和Visfatin水平的变化和不良反应的发生情况。结果：治疗后，观察组空腹血糖(FBG)、餐后2 h血糖(2hPBG)、糖化血红蛋白(HbA1c)均明显低于对照组[(6.58±1.30)mmol/L vs. (7.47±1.44)mmol/L，(9.20±1.22)mmol/L vs. (10.36±1.31)mmol/L，(5.23±0.46)% vs. (5.88±0.62)%](P＜0.05)；观察组最大血糖波动幅度(LAGS)、平均血糖波动幅度(MAGE)均明显低于对照组低，日平均达标率明显高于对照组[(7.43±1.26)mmol/L vs. (8.58±1.59)mmol/L，(3.39±0.42)mmol/L vs. (5.21±0.69)mmol/L，(90.34±2.40)% vs. (82.01±2.15)%](P＜0.05)；观察组胰岛素β细胞(HOMA-β)明显高于对照组，胰岛素抵抗指数(HOMA-IR)明显低于对照组[(53.84±6.20) vs. (41.85±5.03)，(2.84±0.40) vs. (3.72±0.72)](P＜0.05)；观察组血清RBP4、Leptin、Visfatin水平均明显低于对照组[(8.30±1.20)mg/L vs. (10.57±1.65)mg/L，(8.23±1.42)μg/L vs. (10.84±1.79)μg/L，(17.40±2.42)μg/L vs. (24.03±3.06)μg/L](P＜0.05)。两组治疗期间均未发生头晕、低血糖等药物不良反应。结论：吡格列酮联合阿卡波糖治疗2型糖尿病患者的临床效果显著由于单用阿卡波糖的患者，其可显著患者降低血糖水平和改善IR，其内在机制可能和降低血清RBP4、Leptin、Visfatin的表达相关。

英文摘要:

ABSTRACT Objective: To study the effect of pioglitazone combined with acarbose on the serum RBP4, leptin and visfatin levels of patients with type 2 diabetes mellitus. Methods: 80 patients of type 2 diabetes mellitus who admitted in our hospital from October 2015 to October 2017 were selected and divided into the observation group (n=46) and the control group (n=44) according to random number table. The control group was treated by acarbose on the basis of routine treatment, while the observation group was combined with piogli- tazone on the basis of control group, all the patients were treated continuously for 12 weeks. The changes of blood glucose, dynamic blood glucose, islet cell function, serum RBP4, leptin and visfatin levels before and after treatment and incidence of adverse reactions were compared between the two groups. Results: After treatment, the fasting blood glucose (FBG), postprandial 2h blood glucose (2hPBG) and glycosylated hemoglobin (HbA1c) of observation group were significantly lower than those of the control group [(6.58±1.30)mmol/L vs. (7.47±1.44)mmol/L，(9.20±1.22)mmol/L vs. (10.36±1.31)mmol/L，(5.23±0.46)% vs. (5.88±0.62)%](P＜0.05); the max- imal blood glucose fluctuation range (LAGS) and the average blood glucose fluctuation range (MAGE) of observation group were signifi- cantly lower than those of the control group, and the average daily rate of compliance was significantly higher than that of the control group [(7.43±1.26)mmol/L vs. (8.58±1.59)mmol/L, (3.39±0.42)mmol/L vs. (5.21±0.69)mmol/L, (90.34±2.40)% vs. (82.01±2.15)%](P＜0.05); the insulin beta cells (HOMA- β) of observation group were significantly higher than that of the control group, and the insulin resistance index (HOMA-IR) was significantly lower than that of the control group [(53.84±6.20) vs. (41.85±5.03), (2.84±0.40) vs. (3.72±0.72)](P＜0.05); the serum RBP4, leptin and visfatin levels of observation group were significantly lower than those of the control group [(8.30±1.20)mg/L vs. (10.57±1.65)mg/L, (8.23±1.42)μg/L vs. (10.84±1.79)μg/L, (17.40±2.42)μg/L vs. (24.03±3.06)μg/L](P＜0.05). There was no adverse reactions such as dizziness and hypoglycemia occurred in the two groups during treatment. Conclusion: Pioglitazone combined with acarbose is more effective in treatment of type 2 diabetes mellitus than acarbose alone, it can significantly reduce the blood glucose level and improve the IR, which may be related to the decrease of serum RBP4, leptin and visfatin levels.

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