格列吡嗪联合阿卡波糖应用于初诊Ⅱ型糖尿病临床治疗中效果分析

　　[摘要] 目的 研究格列吡嗪聯合阿卡波糖治疗初诊2型糖尿病患者的临床效果。方法 方便选取100例于2015年2月—2017年1月期间入院治疗的2型糖尿病患者，随机分为观察组、对照组各50例。对照组患者给予格列吡嗪片，观察组给予阿卡波糖片联合格列吡嗪片，其中格列吡嗪片的剂量在对照组基础上减半。比较所有患者治疗前后FBG、2 hPBG、HbA1c、空腹C肽、肌酐等常规指标的水平，同时检测FIns、2 hIns、FGC、2 hGC、FGLP-1以及2 hGLP-1，比较治疗过程中低血糖事件以及不良反应发生情况，评价两种方案的疗效和安全性差异。结果 ①两组患者治疗前各指标比较差异无统计学意义（P>0.05）；治疗后，观察组各项指标均显著改善，对照组患者的空腹血糖、餐后2 h血糖、HbA1c水平有显著改善差异有统计学意义（P<0.05）；治疗后组间比较，研究组空腹血糖和餐后2 h血糖为（5.57±1.02）、（7.35±1.24）mmol/L，与对照组相比差异无统计学意义（t=0.275、0.356，P>0.05）；观察组患者的HbA1c水平为（6.21±0.74）%，明显低于对照组（7.28±0.685），空腹C肽和肌酐分别为（2.19±0.48）ng/mL、（79.85±9.05）μmol/L，显著高于对照组，组间比较差异有统计学意义（t=4.521、3.642、3.178，P<0.05）。②两组患者治疗前，FIns、2 hIns、FGC、2 hGC、FGLP-1以及2 hGLP-1等指标组间比较差异无统计学意义（P>0.05）。治疗后，两组患者各指标均有一定改善，观察组2 hIns、FGLP-1以及2 hGLP-1分别为（36.8±4.0）mIU/mL、（26.5±5.4）pmol/L、（27.10±4.8）pmol/L，明显高于对照组（33.5±3.4）mIU/mL、（22.4±4.3）pmol/L、（23.5±3.9）pmol/L，FIns、FGC和2 hGC分别为（6.5±1.3）mIU/mL、（45.8±3.0）pmol/L、（41.8±4.5）pmol/L，显著低于对照组（7.6±1.5）mIU/mL、（48.5±3.5）pmol/L、（46.8±3.9）pmol/L，差异有统计学意义（P<0.05）。③观察组患者不良反应发生率为8.0%，对照组不良反应发生率为12.0%，其中2例患者出现低血糖反应，组间比较，差异有统计学意义（P<0.05）。结论 格列吡嗪联合阿卡波糖用于初诊2型糖尿病患者的治疗，不仅空腹血糖和餐后2 h血糖水平控制效果更好，且HbA1c水平也相对降低，低血糖事件减少，不良反应发生率降低，值得临床推广应用。
　　[关键词] 格列吡嗪；阿卡波糖；2型糖尿病；血糖
　　[中图分类号] R5 [文献标识码] A [文章编号] 1674-0742（2018）01（c）-0018-04
　　[Abstract] Objective This paper tries to study the clinical effect of glipizide combined with acarbose in the treatment of newly diagnosed patients with type 2 diabetes. Methods 100 patients with type 2 diabetes admitted to the hospital during February 2015 and January 2017 were conveient selected randomly divided into two groups： the observation group and the control group， with 50 cases for each group. The control group was treated with Glipizide tablets， and the observation group was treated with the Acarbose tablet joint Glipizide tablets， and the dose of Glipizide tablets was halved on the basis of the control group. To record the level of FBG， 2 hPBG， HbA1c， fasting C peptide， creatinine before and after treatment， at the same time， to test FIns， 2 hIns， FGC， 2 hGC， FGLP-1 and 2 hGLP-1， and hypoglycemic events and adverse events during treatment. Results ①Before treatment， there were no significant differences in each index of the two groups of patients（P>0.05）；after treatment， the indicators in the observation group were significantly improved. In the control group， FBG， 2 hBG and HbA1c levels were improved significantly（P<0.05）； After treatment， the study group of FBG and 2 hBG was（5.57±1.02），（7.35±1.24）mmol/L， with no significant difference compared with the control group（t=0.275， 0.356，P>0.05）； HbA1c for the observation group was（6.21±0.74）%， which was significantly lower than the control group of（7.28±0.68）%， fasting C peptide and serum creatinine were relatively （2.19±0.48）ng/mL and（79.85±9.05）μmol/L， significantly higher than the control group， comparison between groups（t=4.521， 3.642，3.178，P<0.05）. ②Before treatment， there were no significant differences between groups of FIns， 2 hIns， FGC， 2 hGC， FGLP-1 and 2 hGLP-1（P>0.05）. After treatment， the indexes of two groups were improved， compared between the two groups， 2 hIns， FGLP-1 and 2 hGLP-1 for the observation group were relatively（36.8±4.0）mIU/mL，（26.5±5.4）pmol/L，（27.10±4.8）pmol/L， significantly higher than those in the control group of（33.5±3.4）mIU/mL，（22.4±4.3）pmol/L，（23.5±3.9）pmol/L， FIns， FGC and 2 hGC were（6.5±1.3）mIU/mL，（45.8±3.0）pmol/L，（41.8±4.5）pmol/L， significantly lower than the control group of（7.6±1.5）mIU/mL， （48.5±3.5）pmol/L，（46.8±3.9）pmol/L， significantly different（P<0.05）. ③The incidence of adverse reactions was 8.0% in the observation group and 12.0% in the control group， and hypoglycemia occurred in 2 patients. The difference between the two groups was significant（P<0.05）. Conclusion In the treatment of newly diagnosed patients with type 2 diabetes， glipizide combined with acarbose can not only control the FBG and 2 hBG， and the HbA1c level is relatively reduced， hypoglycemia events decrease， the incidence of adverse reactions decreased， it is worthy of clinical application.