二甲双胍分别联合西格列汀与吡格列酮治疗2型糖尿病的效果观察

目的观察并分析二甲双胍分别联合西格列汀、吡格列酮治疗2型糖尿病（T2DM）的临床效果及安全性。方法将2011年1月至2012年12月我院收治的76例T2DM患者随机分为A（n=40）、B（n=36）两组，A组患者予二甲双胍＋西格列汀方案，B组予二甲双胍＋吡格列酮方案，疗程12周。12周后对比两组患者血糖浓度、临床疗效及药物不良反应。结果（1）服药12周后，A、B两组空腹血糖[（6．4±1．8）、（7．0±1．9）mmolfL]、餐后2h血糖[（8．1±2．7）、（9．5±2．8）mmol／L]及糖化血红蛋白[（6．2±2．1）％、（7．1±2．2）％]均较治疗前明显下降[（9．4±2．4）、（9．1±2．5）mmol／L与（13．6±4．5）、（13．3±4．9）mmol／L与（9．2±2．4）％、（8．9±2．6）％，t值分别为6．325、4．013、6．628、4．040、5．950、3．171，P均〈0．05]。A组患者餐后2h血糖浓度（8．1±2．7）mmolfL明显低于B组（9．5±2．8）mmol／L（t=2．214，P=0．030）。（2）A组患者总有效率90．0％（36／40）略高于B组83．3％（30／36），差异无有统计学意义（x2=0．269，P：0．604）。（3）A、B两组用药期问分别发生药物不良反应10例（25．O％）、11例（30．6％），两组不良反应发生率比较差异无统计学意义（x2=0．292，P=0．589）。结论二甲双胍分别联合西格列汀、吡格列酮方案均是治疗T2DM的有效方案，前者临床效果具有优势，尤其是对降低餐后血糖优势明显。

Clinical efficacy of metformin combined with sitagliptin or pioglitazone in treatment of type 2 diabetes mellitus

Objective To investigate clinical efficacy and safety of metformin combined with sitagliptin or pioglitazone in treatment of type 2 diabetes mellitus （T2DM）. Methods Senvnty-six patients with T2DM hospitalized from January 2011 to December 2012 were randomly divided into A（ n = 40） and B （n = 36） group. Patients in group A were given mefformin plus sitagliptin scheme for 12 weeks, and in group B were given mefformin plus pioglitazone scheme for 12 weeks. The blood glucose level was measured and clinical efficacy and adverse drug reactions during treatment were record. Results （1） Fasting plasma glucose （FPG）, 2 h postprandial blood glucose（2 hPBG） and glycosylated hemoglobin（GH） in A and B group after 12 weeks of treatment were （6. 4 ± 1.8） mmol/L, （7. 0 ±1.9） mmol/L; （8.1 ± 2. 7） mmol/L, （9. 5 ±2. 8） mmol/L; （ 6. 2 ± 2. 1 ） %, （7.1± 2. 2 ） %, lower than that of pre-treatment （ （ 9.4 ± 2.4） mmol/L, （ 9. 1 ± 2. 5 ） mmol/L; （13.6±4.5） mmol/L,（13.3 ±4.9） mmol/L;（9.2 ±2.4）%,（8.9 ±2.6）% and the difference were significant （t = 6. 325,4. 013,6. 628 ,4. 040,5. 950,3. 171 respectively, P 〈 0. 05 ）. 2 hPBG level of group A was （8.1 ±2. 7） mmol/L,lower than that of group B （ （9. 5 ±2. 8） mmol/L,t =2. 214,P =0. 030）. （2） Efficiency in group A was 90. 0% （36/40） ,slightly higher than that of group B （83.3% （30/36）） ,but the difference was not statistically significance （ X2 = 0. 269, P = O. 604 ）. （ 3 ） There were no seriously adverse drug reactions in two groups. Rates of adverse reactions in two groups were 25.0% （ 10 cases） ,30. 6% （ 11 cases） respectively （ X2 = 0. 292 ,P = 0. 589 ）. Conclusion Both treatment plans were proved effective in treatment of patients with T2DM. Compared with plan of metformin plus pioglitazone, mefformin plus sitagliptin was showed a comparative advantage in clinical efficacy, especially with outstanding curative effect in reducing postprandial blood glucose.