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目的探讨瑞格列奈和那格列奈对2型糖尿病患者的疗效及胰岛β细胞功能的影响。方法采用随机对照的方法,125例初诊、未经降糖药物治疗的2型糖尿病患者分为瑞格列奈治疗组(A组)65例和那格列奈治疗组(B组)60例,分别给予瑞格列奈(1mg,每天3次)或那格列奈(120mg,每天3次)治疗8周,治疗前及治疗后测定空腹血糖(FPG)、餐后血糖(PPG)、糖化血红蛋白(Hb A1c)、空腹胰岛素(FINS)、餐后胰岛素(PINS)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白(LDL)及高密度脂蛋白(HDL)。结果瑞格列奈及那格列奈治疗后空腹血糖(FPG)、餐后血糖(PPG)及糖化血红蛋白(Hb A1c)均有明显降低(P<0.01),瑞格列奈降低的更为明显(P<0.01);治疗后空腹胰岛素(FINS)和餐后胰岛素(PINS)均明显升高(P<0.05或P<0.01),而以那格列奈升高的更为明显(P<0.05或P<0.01);治疗后瑞格列奈组的胰岛素抵抗指数(HOMA-IR)明显降低(P<0.01),而那格列奈组未发现降低;治疗后2组胰岛β细胞功能指数(HOMA-B)均显著升高(P<0.01),而以那格列奈组升高的更为明显(P<0.01)。此外,那格列奈可以明显降低TC(P<0.01)、TG(P<0.01)和LDL(P<0.01),升高HDL(P<0.05),而未发现瑞格列奈组对脂质代谢有影响。结论那格列奈(1mg,tid)和瑞格列奈(120mg,tid)均能通过显著降低血糖而改善初诊2型糖尿病患者胰岛β细胞功能,胰岛素分泌量得到改善。瑞格列奈主要通过改善胰岛素抵抗发挥降糖作用,而那格列奈主要通过改善胰岛β细胞功能发挥降糖作用。
Objective To investigate the effects of repaglinide and nateglinide on the efficacy and islet β-cell function in type 2 diabetic patients. Methods A randomized controlled clinical trial was conducted in 125 patients with newly diagnosed type 2 diabetes who were not treated with hypoglycemic drugs. The patients were divided into repaglinide treatment group (A group) and nateglinide treatment group (B group) The patients were treated with repaglinide (1mg three times a day) or nateglinide (120mg three times a day) for 8 weeks respectively. Before and after treatment, fasting blood glucose (FPG), postprandial blood glucose (PPG), glycated hemoglobin Hb A1c, FINS, PINS, TC, TG, LDL and HDL were measured. Results The levels of fasting blood glucose (FPG), postprandial blood glucose (PPG) and Hb A1c in repaglinide and nateglinide groups were significantly lower (P <0.01) and repaglinide was lower (P <0.01). Fasting insulin (FINS) and postprandial insulin (PINS) were significantly increased after treatment (P <0.05 or P <0.01), but were significantly higher with nateglinide (P <0.05 (P <0.01), but not in nateglinide group; after treatment, the insulin resistance index (HOMA-IR) in repaglinide group was significantly lower than that in nateglinide group HOMA-B) were significantly increased (P <0.01), while those in nateglinide group were significantly higher (P <0.01). In addition, nateglinide significantly reduced TC (P <0.01), TG (P <0.01) and LDL (P <0.01), increased HDL Metabolism is affected. Conclusions Both nateglinide (1 mg, tid) and repaglinide (120 mg, tid) can improve pancreatic β-cell function in newly diagnosed type 2 diabetic patients by significantly lowering blood glucose levels, and improve insulin secretion. Repaglinide exerts its hypoglycemic effect mainly by improving insulin resistance, whereas nateglinide exerts its hypoglycemic effect primarily by improving pancreatic β-cell function.