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目的 观察胰岛素强化治疗对成人晚发自身免疫性糖尿病 (LADA)患者胰岛功能的保护作用。 方法 将病程在 1年以内的LADA组患者 70例 ,随机分为胰岛素强化治疗组 (A组 )和非胰岛素治疗组 (B组 )。A组使空腹血糖 (FPG)控制在 <6 .1mmol L ,餐后 2h血糖 ( 2hPG)控制在<8mmol L ,糖化血红蛋白 (HbA1 c)控制在 <7%。B组未进行胰岛素强化治疗 ,血糖、GHbA1 c未达到A组治疗标准。二组患者随访治疗时间 6年。A、B两组完成随访观察各 32例。 结果 随病程的延长 ,酮症发生率B组高于A组 (P <0 .0 5 ) ;A、B两组在开始进入临床观察时 ,其C肽释放试验各时相值差异无显著意义 (P >0 .0 5 ) ;经 2、4、6年胰岛功能动态观察 ,2年时A组的胰岛功能比治疗前好转。随病程延长 ,B组C肽水平进行性下降 ,而A组C肽水平相对稳定 ,较B组下降明显延迟。 结论 对LADA患者及时进行胰岛素治疗可保护残存胰岛β细胞功能 ,防止糖尿病并发症的发生。
Objective To observe the protective effects of intensive insulin therapy on islet function in patients with late-onset autoimmune diabetes mellitus (LADA). Methods Seventy patients with LADA group within one year duration were randomly divided into insulin intensive treatment group (A group) and non-insulin treatment group (B group). In group A, fasting plasma glucose (FPG) was controlled at <6.1 mmol L, postprandial 2h glucose (2 hPG) at <8 mmol L, and hemoglobin A1c (HbA1 c) at <7%. B group did not undergo insulin-intensive therapy, blood glucose, GHbA1c did not meet the standard of treatment of A group. Two groups of patients followed up for 6 years. Groups A and B were followed up for 32 cases. Results With the prolongation of the course of disease, the incidence of ketosis in group B was higher than that in group A (P <0.05). There was no significant difference in the values of C-peptide release between groups A and B at the beginning of clinical observation (P> 0.05). After 2, 4 and 6 years of dynamic observation of islet function, the function of islet in group A was better than that before treatment at 2 years. With the prolongation of duration, the level of C-peptide in group B decreased progressively, while the level of C-peptide in group A was relatively stable, which was significantly delayed than that in group B. Conclusions Insulin treatment of LADA patients in time can protect the function of residual islet β cells and prevent the occurrence of diabetic complications.