标题：短期胰岛素泵强化治疗初诊断2型糖尿病酮症倾向的临床效果

      作者：邓黎，黄文彩，黄文欢    东莞市厚街医院内分泌科，广东 东莞 523960

      卷次： 2022年33卷19期

      【摘要】 目的 观察短期胰岛素泵强化治疗初诊断2型糖尿病酮症倾向的临床效果。方法 选取2019年10月至2020年11月东莞市厚街医院内分泌科收治的106例初诊断2型糖尿病酮症倾向患者纳入研究，采用随机数表法分为观察组和对照组各53例。对照组患者采用二甲双胍治疗，观察组患者则采用短期胰岛素泵强化治疗。治疗两周后，比较两组患者的空腹血糖(FBG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbAlc)水平及血糖达标时间、胰岛素分泌指数(HOMA-IS)、胰岛素抵抗指数(HOMA-IR)和C反应蛋白(CRP)、白细胞介素-6 (IL-6)、血清肿瘤坏死因子-α (TNF-α)、超氧化物歧化酶(SOD)、还原型谷胱甘肽(RGSH)、丙二醇(MDA)水平。结果 治疗后，两组患者的FBG、2 hPG、HbAlc水平均下降，且观察组[(6.19±1.01) mmol/L、(8.13±1.65) mmol/L、(5.12±0.76)%]明显低于对照组[(8.77±1.23) mmol/L、(12.41±2.14) mmol/L、(6.77±0.69)%]，而血糖达标时间为(6.12±1.45) d，明显短于对照组的(9.87±1.56) d，差异均有统计学意义(P<0.05)；治疗后，两组患者的HOMA-IS均下降，且观察组为(51.12±5.19)，明显低于对照组的(65.31±5.76)，而HOMA-IR升高，且观察组为(4.98±0.32)，明显高于对照组的(3.13±0.39)，差异均有统计学意义(P<0.05)；治疗后，两组患者的CRP、IL-6、TNF-α水平均下降，且观察组[(3.12±0.42) mg/L、(6.19±1.18) ng/mL、(1.21±0.19) ng/mL]明显低于对照组[(4.31±0.51) mg/L、(8.98±1.76) ng/mL、(1.89±0.21) ng/mL]，差异均有统计学意义(P<0.05)；治疗后，两组患者的SOD、RGSH水平均升高，且观察组分别为(39.81±3.41) IU/L、(189.41±25.19) μmol/L，明显高于对照组的(33.31±3.55) IU/L、(175.87±22.99) μmol/L，而MDA水平均降低，且观察组为(2.17±0.22) μmol/L，明显低于对照组的(3.09±0.28) μmol/L，差异均有统计学意义(P<0.05)。结论 短期胰岛素泵强化治疗初诊断2型糖尿病酮症倾向患者可缩短血糖达标时间，降低胰岛素抵抗、氧化应激和炎症反应，临床应用效果显著。
      【关键词】 2型糖尿病；酮症倾向；初诊断；胰岛素泵强化治疗；血糖；炎症反应；氧化应激
      【中图分类号】 R587.1 【文献标识码】 A 【文章编号】 1003—6350（2022）19—2492—04

Effect of short-term insulin pump intensive therapy on Ketosis tendency in newly diagnosed type 2 diabetes.DENG Li, HUANG Wen-cai, HUANG Wen-huan.
Department of Endocrinology, Dongguan Houjie Hospital, Dongguan523960, Guangdong, CHINA
【Abstract】 Objective To analyze the effect of short-term insulin pump intensive therapy on Ketosis tendencyin newly diagnosed type 2 diabetes. Methods A total of 106 newly diagnosed patients with Ketosis tendency of type 2diabetes admitted to Dongguan Houjie Hospital from October 2019 to November 2020 were enrolled in the study, whichwere divided into two groups (53 cases in each group ) by random number table method. The control group was treatedwith metformin, and the observation group was treated with short-term insulin pump intensive therapy. After 2 weeks oftreatment, the levels of fasting blood glucose (FBG), 2 h postprandial blood glucose (2 hPG), glycosylated hemoglobin(HbAlc), time to reach the target blood glucose, homeostasis model assessment of insulin resistance (HOMA-IS), andho-meostasis model assessment of insulin resistance index (HOMA-IR) were compared between the two groups, as well asC-reactive protein (CRP), interleukin-6 (IL-6), serum tumor necrosis factor-α (TNF-α), superoxide dismutase (SOD),reduced glutathione (RGSH), propylene glycol (MDA) levels. Results After treatment, the FBG, 2 hPG, and HbAlclevels of the two groups all decreased; the levels in the observation group were significantly lower than those in the con-trol group: (6.19±1.01) mmol/L vs (8.77±1.23) mmol/L, (8.13±1.65) mmol/L vs (12.41±2.14) mmol/L, (5.12±0.76)% vs(6.77±0.69)%; the time to reach the target blood glucose was (6.12±1.45) d, which was significantly shorter than (9.87±1.56) d in the control group; the differences were statistically significant (P<0.05). After treatment, HOMA-IS de-creased in both groups, and HOMA-IS in the observation group was 51.12±5.19, which was significantly lower than65.31±5.76 in the control group; HOMA-IR in the two groups increased, and HOMA-IR in the observation group was4.98±0.32, which was significantly higher than 3.13±0.39 in the control group; the differences were statistically signifi-cant (P<0.05). After treatment, the levels of CRP, IL-6, and TNF-α in the two groups decreased, and the levels in theobservation group were (3.12±0.42) mg/L, (6.19±1.18) ng/mL, (1.21±0.19) ng/mL, which were significantly lowerthan (4.31±0.51) mg/L, (8.98±1.76) ng/mL, (1.89±0.21) ng/mL in the control group, with statistically significant differ-ence (P<0.05). After treatment, the levels of SOD and RGSH in the two groups increased, and the levels in the observa-