标题：门冬胰岛素对Ⅱ型糖尿病患者心血管病变的影响

      作者：熊英 1，马红娥 2，刘宝堂 3，朱学进 4，韩宝珍 3，薛一南 3    (略阳县人民医院内科 1、呼吸内分泌科 2、心血管内科 3、消化内科 4，陕西 汉中 724300)

      卷次： 2018年29卷19期

      【摘要】 目的 评价门冬胰岛素和常规人胰岛素对Ⅱ型糖尿病患者心血管病变发生率的影响。方法 回顾性分析2012年1月至2013年12月在略阳县人民医院呼吸内分泌科治疗的759例Ⅱ型糖尿病患者的临床资料，根据患者用药方法不同，将患者分为常规人胰岛素组(n=373)和门冬胰岛素组(n=386)。对患者进行42个月的随访，比较两组患者的临床特征、患者累积生存率及心脑血管、大血管、微血管疾病发生率，评价门冬胰岛素治疗与患者并发症发生的相关性。结果 与常规人胰岛素组比较，门冬胰岛素组患者大血管疾病、冠心病、心肌梗死与短暂性脑缺血发作(TIA)等并发症的发病率均明显降低，差异均有统计学意义(P<0.05)；Cox回归模型分析表明，门冬胰岛素治疗是预防患者发生大血管疾病、冠心病、心肌梗死与中风/TIA并发症的保护因素(P<0.05)；Kaplan-Meier曲线显示，门冬胰岛素组累积生存率显著高于常规人胰岛素组(79.6% vs 66.2%，HR=0.431，95%CI：0.258~0.782，P<0.01)。结论 门冬胰岛素治疗能降低Ⅱ型糖尿病患者心脑血管及大血管病变的发病率，提高患者生存率，值得临床推广应用。
      【关键词】 门冬胰岛素；Ⅱ型糖尿病；心血管病变；疗效；生存率
      【中图分类号】 R587.1 【文献标识码】 A 【文章编号】 1003—6350（2018）19—2692—04

Effect of insulin aspart on cardiovascular disease in patients with type 2 diabetes.
XIONG Ying 1, MA Hong-e 2, LIUBao-tang 3, ZHU Xue-jin 4, HAN Bao-zhen 3, XUE Yi-nan 3. Department of Internal Medicine 1, Department of RespiratoryEndocrinology 2, Department of Cardiology 3, Department of Gastroenterology 4, the People's Hospital of Lueyang County,Hanzhong 724300, Shaanxi, CHINA
【Abstract】 Objective To evaluate the effects of insulin aspart and conventional human insulin on the inci-dence of cardiovasculr disease in patients with type 2 diabetes. Methods The clinical data of 759 patients with type 2diabetes mellitus, who treated in Department of Respiratory Endocrinology of the People's Hospital of Lueyang Countyduring January 2012 and December 2013, were retrospectively analyzed. According to the different methods of adminis-tration, the patients were divided into the conventional human insulin group (n=373) and the insulin aspart group (n=386). The patient was followed up for 42 months. The clinical characteristics, cumulative survival rate and incidence ofcardiovascular and cerebrovascular, macrovascular and microvascular diseases were compared between the two groups.The correlation between insulin aspart and complication was evaluated. Results Compared with the conventional hu-man insulin group, the incidence of complications of macrovascular disease, coronary heart disease, myocardial infarc-tion, and transient ischemic attack (TIA) was significantly lower in the insulin aspart group, and the difference was statis-tically significant (all P<0.05). Cox regression model analysis showed that insulin aspart was the protective factor for ma-jor vascular disease, coronary heart disease, myocardial infarction and stroke/TIA complications (all P<0.05). The Ka-plan-Meier curve showed that the cumulative survival rate of the insulin asparts group was significantly higher than thatof the conventional human insulin group (79.6% vs 66.2%, HR=0.431, 95%CI 0.258-0.782, P<0.01). Conclusion Theapplication of insulin aspart can reduce the incidence of cardiovascular and cerebrovascular and macrovascular diseasesin patients with type 2 diabetes, and improve the survival rate of patients. It is worthy of clinical application.
      【Key words】 Insulin aspart; Type 2 diabetes; Cardio vascular disease; Curative effect; Survival rate·论 著·doi:10.3969/j.issn.1003-6350.2018.19.008