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目的:探讨降糖药物和胰岛素控制血糖对不同临床分期糖尿病视网膜病变进程的影响。方法:收集糖尿病伴有视网膜病变的患者78例。采用随机表法,将糖尿病视网膜病变患者分为药物控制血糖组和胰岛素控制组,药物治疗组38例,胰岛素治疗组40例,使血糖达到控制标准。评价干预前后患者血清C肽、糖化血红蛋白、胰岛素抵抗指数,以及糖尿病视网膜病变分级。结果:药物控制组治疗前后2 h CP、以及糖化血红蛋白测定差异无统计学意义(p>0.05)。胰岛素组治疗前后,血清空腹C肽、2 h CP差异有统计学意义(p<0.05);而糖化血红蛋白、胰岛素抵抗指数差异无统计学意义(p>0.05)。药物组治疗前Ⅰ期、Ⅱ期、Ⅲ期、Ⅳ期、Ⅴ期、Ⅵ期病例数和治疗后相比,差异有统计学意义(p<0.05),视网膜病变分级程度明显增高。胰岛素组治疗前Ⅰ期、Ⅱ期、Ⅲ期、Ⅳ期、Ⅴ期、Ⅵ期病例数和治疗后相比,差异有统计学意义(p<0.05)。药物组和胰岛素组间视网膜病变分级差异无统计学意义(p>0.05);治疗后差异有统计学意义(p<0.05)。结论:胰岛素能够提高糖尿病患者血清C肽,降低胰岛素抵抗,和药物控制血糖相比,能够延缓糖尿病视网膜病变的进展。
Objective: To investigate the effect of hypoglycemic agents and insulin-controlled blood glucose on the progression of diabetic retinopathy with different clinical stages. Methods: 78 cases of diabetic patients with retinopathy were collected. Using random table method, patients with diabetic retinopathy were divided into drug-controlled blood glucose control group and insulin control group. Drug treatment group (38 cases) and insulin treatment group (40 cases) made blood glucose reach the control standard. Patients before and after intervention evaluation of serum C-peptide, HbA1c, insulin resistance index, and diabetic retinopathy grading. Results: There were no significant differences in CP and HbA2c between the two groups before and after treatment (p> 0.05). Serum fasting C-peptide, 2 h CP had significant difference (P <0.05) before and after insulin treatment, but there was no significant difference between HbA1c and insulin resistance index (p> 0.05). The number of cases in the first, second, third, fourth, fifth and sixth pre-treatment groups was significantly different from that before treatment (p <0.05), and the grade of retinopathy was significantly increased. The insulin group before treatment Ⅰ, Ⅱ, Ⅲ, Ⅳ, Ⅴ and Ⅵ of the number of cases compared with after treatment, the difference was statistically significant (p <0.05). There was no significant difference in the grading of retinopathy between the drug group and the insulin group (p> 0.05). The difference was statistically significant (p <0.05). Conclusion: Insulin can increase serum C-peptide in patients with diabetes mellitus, reduce insulin resistance, and can delay the progression of diabetic retinopathy compared with drug control of blood glucose.