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目的研究二甲双胍对2型糖尿病合并动脉粥样硬化(AS)患者血糖波动及动脉粥样硬化病变的影响。方法收集2014年1月至2015年6月期间本院确诊的2型糖尿病合并AS的患者98例,随机分为观察组与对照组,每组49例。观察组给予盐酸二甲双胍一日2次,每次0.25 g为起始剂量;对照组给予格列齐特,一日1次,每次80 mg为起始剂量,调控剂量以控制血糖达标,治疗6个月。比较两组的平均血糖(MBG)、餐后血糖漂移(PPGE)、平均血糖漂移幅度(MAGE)、日间血糖平均绝对差(MODD)、颈动脉内膜中层厚度(c IMT)、超敏C反应蛋白(hs-CRP)、瘦素(LP)、脂联素(ADP)、几丁质酶-3样蛋白-1(YKL-40)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白-胆固醇(HDL-C)及低密度脂蛋白-胆固醇(LDL-C)。结果与治疗前相比,观察组及对照组治疗后MBG、PPGE、MAGE和MODD均下降,差异均具有统计学意义(P<0.05或0.01),且观察组较对照组PPGE和MAGE下降更明显(P<0.05);与对照组治疗后相比,观察组c IMT减少,TC水平下降,HDL-C水平上升,差异均具有统计学意义(P<0.05或0.01);观察组治疗后hs-CRP、LP和YKL-40水平均下降、ADP水平上升,差异具有统计学意义(P<0.05或0.01),与对照组相比,上述指标改善更为明显(P<0.05或0.01)。结论二甲双胍可有效控制2型糖尿病合并AS患者的血糖,患者血糖波动小,血管炎性指标也可获得明显改善,可降低患者潜在的心血管风险。
Objective To investigate the effect of metformin on blood glucose and atherosclerosis in type 2 diabetic patients with atherosclerosis (AS). Methods A total of 98 patients with type 2 diabetes mellitus complicated with AS diagnosed in our hospital from January 2014 to June 2015 were randomly divided into observation group and control group with 49 cases in each group. The observation group was given metformin hydrochloride twice a day, each 0.25 g for the initial dose; the control group was given gliclazide, once a day, each 80 mg as the starting dose, the dose to control blood glucose compliance, treatment 6 Months. The mean blood glucose (MBG), postprandial blood glucose drift (PPGE), mean blood glucose drift (MAGE), mean daytime blood glucose (MODD), carotid artery intima-media thickness (c IMT) (Hs-CRP, LP, ADP, YKL-40, TC, TG, High-density lipoprotein-cholesterol (HDL-C) and low-density lipoprotein-cholesterol (LDL-C). Results Compared with those before treatment, the levels of MBG, PPGE, MAGE and MODD in observation group and control group decreased after treatment, the difference was statistically significant (P <0.05 or 0.01), and the decrease of PPGE and MAGE in observation group and control group was more obvious (P <0.05 or P <0.05). Compared with the control group, the cIMT decreased, the TC level decreased and the HDL-C level increased in the observation group, the differences were statistically significant (P <0.05 or 0.01) The levels of CRP, LP and YKL-40 decreased and the level of ADP increased, the difference was statistically significant (P <0.05 or 0.01). Compared with the control group, the above indexes improved more obviously (P <0.05 or 0.01). Conclusions Metformin can effectively control the blood sugar of patients with type 2 diabetes mellitus complicated with AS. The patient’s blood glucose fluctuation is small and the vasculitis index can be significantly improved, which can reduce the potential cardiovascular risk.