二甲双胍与阿卡波糖分别联合胰岛素治疗2型糖尿病的最小成本分析

目的:比较二甲双胍与阿卡波糖分别联合胰岛素治疗2型糖尿病的效果和成本。方法:运用药物经济学最小成本分析法,从病人角度出发,对治疗效果、成本及成本的影响因素进行分析。结果:2种治疗方案疗效之间的差异无统计学意义。二甲双胍组人均治疗总成本为1941 46元,药物成本为138 .86元;阿卡波糖组人均治疗总成本为2308 .37元,药物成本为229 .82元。成本的影响因素分析显示无统计学意义。结论:二甲双胍组治疗方案相对较优。     

国产阿卡波糖治疗2型糖尿病的药物经济学评价

目的研究国产阿卡波糖治疗2型糖尿病的经济效果。方法选择46例2型糖尿病患者,随机分为两组,治疗组22例,给予国产阿卡波糖胶囊50 mg,tid口服治疗;对照组24例,给予进口阿卡波糖片剂50 mg,tid口服治疗。治疗8周后,观察两组降空腹血糖(FBG)及餐后2 h血糖(2 hPBG)的疗效,并运用药物经济学理论进行回顾性分析。结果用药8周后,治疗组、对照组降空腹血糖的总有效率分别为81.82%、75.00%,降餐后2 h血糖的总有效率分别为86.36%、83.33%,两组间疗效比较差异无显著性(P>0.05)。治疗组、对照组成本分别为707.16元、801.80元。治疗组、对照组不良反应发生率分别为27.27%、54.17%,两组间比较有统计学差异(P<0.05)。结论治疗组效果好,成本低,不良反应少,值得临床推广使用。     

In vitro and in vivo acute antihyperglycemic effects of five selected indigenous plants from Jordan used in traditional medicine

Ethnopharmacological relevance

Achillea santolina L., Pistacia atlantica Desf, Rheum ribes L., Sarcopoterium spinosum (L.) Spach and Teucrium polium L. have traditionally been used as herbal antidiabetic medicines. However their alleged benefits and mechanisms remain elusive.

Aim of the study

This study aimed to evaluate the effect of water extracts of these plants in in vitro and in vivo experiments.

Materials and methods

In vitro enzymatic starch digestion with aqueous extracts from plants at concentrations of 1, 5, 10, 12.5, 25, 50 and 100 mg/ml was assayed using α-amylase and α-amyloglucosidase. Acarbose was used as control and glucose liberation was determined by glucose oxidase method. Oral starch tolerance test (OSTT) and oral glucose tolerance test (OGTT) were determined for the plant extracts at concentrations 125, 250 and 500 mg/kg b.wt. on Sprague-Dawley rats. Blood glucose levels in rats treated with plant extracts and drugs (acarbose or metformin and glipizide) were measured at −30, 0, 45, 90 and 135 min.

Results

Compared to acarbose (IC₅₀ = 1.2 μg/ml), water extracts of Pistacia atlantica, Rheum ribes and Sarcopoterium spinosum exerted significant dose dependent dual inhibition of α-amylase and α-glucosidase in in vitro enzymatic starch digestion bioassay, with IC₅₀s; 46.98, 58.9 and 49.9 mg/ml, respectively. Comparable in vivo results were obtained for starch-fed rats, exhibiting significant acute postprandial antihyperglycemic efficacies. While Achillea santolina and Teucrium polium extracts lacked any favourable in vitro anti-α-amylase and anti-α-glucosidase effect, other modes of action can possibly explain their substantial acute antihyperglycemic activities in starch-treated rats. Except for Pistacia atlantica extracts, none of the investigated extracts qualified for improving the glucose intolerance in fasted rats on glucose loading.

Conclusions

Pistacia atlantica, Rheum ribes and Sarcopoterium spinosum can be considered as potential candidates for amelioration/management of type 2 diabetes.     

甘精胰岛素联合阿卡波糖治疗2型糖尿病疗效观察

目的：观察甘精胰岛素（来得时）联合阿卡波糖（拜唐萍）治疗2型糖尿病患者的临床疗效。方法：选取40例糖化血红蛋白（HbAlc）〉9％的2型糖尿病患者,予每餐口服阿卡波糖,同时每晚22点睡前皮下注射甘精胰岛素治疗3个月,观察治疗前后血糖水平、低血糖发生情况及体质指数（BMI）。结果：治疗后患者的空腹血糖（FPG）、餐后2h血糖（2hPO）、HbAlc较治疗前均显著下降（P〈0．05）;体质指数（BMI）治疗前后无显著性差异（P〉0．05）;低血糖发生率为2．5％。结论：甘精胰岛素联合阿卡波糖能有效降低糖化血红蛋白（HbAlc）〉9％的2型糖尿病患者的血糖,且对体重影响较小,具有安全、方便、依从性高的特点,可作为临床2型糖尿病的治疗方案。     

罗格列酮联合阿卡波糖治疗2型糖尿病的临床疗效研究

目的 探讨罗格列酮联合阿卡波糖治疗2型糖尿病的有效性和安全性.方法 选取2010-2011年来我院门诊内分泌科治疗的符合标准的2型糖尿病患者96例,给予罗格列酮片和阿卡波糖片,定期检测患者空腹血糖、餐后2h血糖和糖化血红蛋白,比较治疗前后变化情况.结果 采用罗格列酮联合阿卡波糖治疗2型糖尿病12周之后,空腹血糖、餐后2h血糖及糖化血红蛋白等指标相对治疗前均有下降,差异有统计学意义（P＜0.05）.其他各项指标均正常,未发生严重不良反应.结论 罗格列酮联合阿卡波糖治疗2型糖尿病安全有效,不良反应少,具有较大的临床意义.     

Glucagon-like Peptide 1 (7-36 hide) Secretion in Response to Luminal Sucrose from the Upper and Lower Gut: A Study Using α-Glucosidase Inhibition (Acarbose)

Background: After nutrient ingestion there is an early response of glucagon-like peptide 1 (GLP-1) immunoreactivity, although GLP-1 is mainly produced in endocrine cells from the lower gut (ileum and colon/rectum), suggesting that indirect stimulation is important after the ingestion of carbohydrates that are predominantly absorbed from the upper intestine.

Methods: To enable contact of sucrose with lower gut mucosa, sucrose was administered by mouth with and without the simultaneous ingestion of 100mg of the α-glucosidase inhibitor acarbose to six normal healthy volunteers.

Results: There was an early increment in GLP-1 15min after sucrose ingestion. With acarbose, sucrose reached the colon approximately 120min after ingestion, as indicated by an increment in breath hydrogen exhalation (p < 0.0001), and GLP-1 release was prolonged (p < 0.0001). The sucrose-related increments in glucose, insulin, C-peptide, and gastric inhibitory polypeptide (GIP) and the suppression of glucagon were only marginally affected by acarbose administration.

Conclusions: GLP-1 release appears to be influenced by indirect mechanisms (early response after sucrose) and by direct luminal contact with lower gut mucosal endocrine cells (late response with acarbose).     

Managing Ulcerative Colitis by Increasing Hydrogen Production Via Oral Administration of Acarbose

The objective of the study was to investigate ulcerative colitis management through oral administration of acarbose. Acarbose has gained importance as a drug used widely to treat Diabetes Mellitus Type 2,as it acts on the small intestine by competitively inhibiting enzymes that delay the release of glucose from complex carbohydrates, thereby specifically reducing postprandial glucose excursion. The main side-effect of treatment with Acarbose, flatulence, occurs when undigested carbohydrates are fermented by colonic bacteria, resulting in considerable amounts of hydrogen. We found that the enteric benefits of Acarbose are partly due to be their ability to neutralise oxidative stress via increased production of H₂ in the gastrointestinal tract. Therefore, some symptoms of ulcerative colitis in human beings can be ameliorated by Acarbose.     

糖耐量异常对冠心病患者氧化应激和血管内皮功能、心率变异性的影响及阿卡波糖的干预作用

目的　研究糖耐量异常对冠心病患者氧化应激和血管内皮功能、心率变异性的影响及阿卡波糖的干预作用。方法　选择伴糖耐量异常的冠心病患者60例为糖耐量异常组,糖耐量正常的冠心病患者30例为糖耐量正常组。所有研究对象均进行血液生物化学指标检查,包括空腹血糖、餐后2　h血糖、总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、丙二醛（MDA）、红细胞超氧化物歧化酶（SOD）、一氧化氮（NO）、内皮素1（ET-1）的检测。24　h动态心电图监测心率变异性,并比较以上指标。糖耐量异常的冠心病患者（糖耐量异常组）随机分为对照组30例与治疗组30例,对照组给予冠心病的常规治疗,治疗组在冠心病常规治疗的基础上加用阿卡波糖50　mg,每天3次,共观察6个月;6个月后两组复查以上检测项目,并比较两组治疗前后及两组治疗后上述指标的变化,分析以上指标的相关性。结果　糖耐量异常组较糖耐量正常组MDA、ET-1水平明显增高,SOD、NO水平明显降低（P＜0.05）。心率变异性指标：糖耐量异常组SDNN、SDNN5、SDANN较糖耐量正常组明显减低（P＜0.05）,糖耐量异常组TRIA、PNN50、rMSSD与糖耐量正常组比较差别无统计学意义。阿卡波糖治疗6个月后,治疗组治疗后与治疗前及对照组治疗后比较MDA、ET-1水平明显下降,SOD、NO水平明显增高,差别有统计学意义。治疗组治疗后SDNN、SDNN5、SDANN较治疗前及对照组治疗后明显增高（P＜0.05）,治疗组TRIA、PNN50、rMSSD治疗前后无明显差异,对照组各项指标治疗前后无明显差异。治疗前后心率变异性指标SDNN的变化值与治疗前后MDA、SOD、NO变化值呈正相关（r＝0.512,r＝0.368,r＝0.420,P＜0.05）。结论　合并糖耐量异常的冠心病患者有更严重的血管内皮功能损伤及自主神经功能异常,氧化应激参与了上述过程。阿卡波糖治疗后氧化应激反应减轻,血管内皮功能及自主神经功能明显改善;阿卡波糖对合并糖耐量异常的冠心病患者的血管内皮功能、自主神经功能损伤有治疗作用。     

西格列汀与阿卡波糖对初发2型糖尿病的疗效比较和胃肠道相关激素的影响研究

目的探讨西格列汀与阿卡波糖对初发2型糖尿病的治疗效果及胃肠道相关激素的影响。方法选取该院2012年5月—2013年12月收治的58例初发2型糖尿病患者为研究对象,随机将其分为两组,各29例,A组患者给予西格列汀治疗,B组患者给予阿卡波糖治疗,对两组患者血糖控制情况（空腹血糖、餐后2 h血糖及糖化血红蛋白）及胃肠道相关激素（胃饥饿素及胃泌素）变化进行比较。结果治疗后两组间血糖、血脂及体重质量指数变化比较,差异无统计学意义（P〉0.05）。A组患者治疗后空腹、餐后2 h胃饥饿素及胃泌素较治疗前明显下降,差异有统计学意义（P〈0.05）,B组患者上述指标则无显著变化,差异无统计学意义（P〉0.05）。结论西格列汀与阿卡波糖治疗初发2型糖尿病疗效均良好,但西格列汀可显著降低患者空腹及餐后胃饥饿素,更安全。     

阿卡波糖与2型糖尿病患者冠心病发病风险的回顾性队列研究

摘 要 目的：探究使用阿卡波糖对新发2型糖尿病（T2DM）人群冠心病发病风险的影响。 方法：使用2012~2015年北京市城镇职工基本医疗保险数据库进行回顾性队列研究,共1 627例新发T2DM患者纳入分析。以患者首次诊断为糖尿病的时间为随访起点,直到出现研究结局、或最后一次就诊日期为观察终点。按照随访期间有无使用阿卡波糖将研究对象分为暴露组与对照组,使用时间依赖的Cox比例风险回归模型分析阿卡波糖用药对冠心病发病的影响;并根据累积暴露水平（累积用药时间/剂量）进行亚组分析。 结果：对研究对象随访4年,发生冠心病共计918例（56.42%）,其中暴露组379例（47.55%）,对照组539例（64.94%）,差异有统计学意义（P<0.05）。与对照组相比,累积用药天数＜60 d、60~180 d和＞180 d组发生冠心病的调整后HR（95%CI）分别为2.08（1.77,2.45）、0.79（0.65,0.97）和0.29（0.22,0.39）;累积用药剂量＜14 000 mg、14 000~48 000 mg和＞48 000 mg组发生冠心病的调整后HR（95%CI）分别为2.02（1.73,2.37）、0.72（0.58,0.89）和0.23（0.17,0.32）。 〖HTH〗结论：〖HTK〗长期使用阿卡波糖（累积用药达一定的天数或者剂量）可以降低新发T2DM患者冠心病的发病风险。