胰岛素泵强化治疗对初诊2型糖尿病患者下肢血管病变发生发展的作用

目的：探讨胰岛素泵强化治疗对延缓初诊2型糖尿病（ T2DM）患者下肢血管病变（ lower-extremity arte-rial disease，LEAD）发生、发展的作用。方法选择2002年1月—2013年12月北京军区总医院内分泌科收治的初诊T2DM 患者524例，按初诊时是否应用胰岛素泵强化治疗分为强化组（ A 组，249例）和非强化组（ B 组，275例），对两组进行回访，收集患者初诊及复诊时一般资料及相关实验室指标，同时按 LEAD 严重程度进行评分并比较。结果①初诊时 A、B 组年龄、BMI、FPG、TG、TC、HDL-C、LDL-C 等一般资料差异无统计学意义（ P ﹥0.05）；A 组 HbA1c 显著高于 B 组（P ﹤0.01）。复诊时 A 组 LDL-C 显著低于 B 组（ P ﹤0.01），其余指标差异无统计学意义（ P ﹥0.05）。②初诊时两组 LEAD 评分比较差异无统计学意义（P ﹥0.05），复诊时 A 组 LEAD 评分显著低于 B 组（ P ﹤0.01）。③Pearson相关分析显示，LEAD 评分与患者年龄、病程、LDL-C 呈显著正相关（r =0.154、0.408、0.221，P ﹤0.05）。结论早期胰岛素泵强化治疗可能通过改善代谢记忆效应延缓初诊 T2DM 患者 LEAD 的发生、发展。

Effect of Insulin Pump Intensive Therapy on Incidence and Development of Lower Limb Vascular Disease in Pa-tients with Type 2 Diabetes Mellitus by Preliminary Diagnosis

Objective To investigate the effect of insulin pump intensive therapy on incidence and development of lower limb vascular disease( LEAD)in patients with type 2 diabetes mellitus( T2DM)by preliminary diagnosis. Methods A total of 524 T2DM patients by preliminary diagnosis during January 2002 and December 2013 were divided into intensive therapy group(group A,n = 249)and non intensive therapy group(group B,n = 275). The return visit was performed in the two groups. The general data and laboratory indexes of preliminary and return visits were collected and compared,and scoring and comparison were also performed according to LEAD severity degree. Results ①There were no significant differences in general data such as age,body mass index( BMI),fasting plasma glucose( FPG), triglyeride(TG),total cholesterol(TC),high density lipoprotein cholesterol(HDL-C)and low density lipoprotein cho-lesterol(LDL-C)during preliminary diagnosis(P ﹥ 0. 05). The glycated hemoglobin(HbA1c)level in group A was sig-nificantly higher than that in group B(P ﹤ 0. 01). During return visit,the LDL-C level in group A was significantly lower than that in group B(P ﹤ 0. 01),but these were no significant differences in other indexes(P ﹥ 0. 05). ②There was no significant difference in LEAD scores in the two groups during preliminary diagnosis(P ﹥ 0. 05),while the score in group A was significantly lower than that in group B during return visit(P ﹤ 0. 01). ③Pearson analysis showed that the LEAD score was positively related to age,disease course and LDL-C level(r = 0. 154,0. 408,0. 221,P ﹤ 0. 05). Conclusion Early insulin pump intensive therapy may delay the incidence and development of lower limb vascular disease in T2DM patients by preliminary diagnosis by improving metabolism and memory effect.