胰岛素不同给药方式治疗2型糖尿病合并社区获得性肺炎研究

目的观察应用双C和MSII治疗2型糖尿病（type 2 diabetes mellitus，T2DM）合并社区获得性肺炎（community acquired pneumonia，CAP）患者强化血糖控制的有效性和安全性。方法将2004年10月至2009年10月在我院住院的未使用过胰岛素治疗的T2DM合并CAP患者99例随机分为双C组（50例）和MSII组（49例），分别给予双C和MSII。双C是应用持续皮下胰岛素输注（CSII）结合动态血糖监测系统（CGMS）一即“双C”方案。MSII是每日多次皮下注射胰岛素（MSII）结合每日八次指尖血糖监测。两组患者应用胰岛素和抗生素治疗后，观察CAP主要症状缓解时间、血糖达标时间、胰岛素用量、低血糖发生频率及肺炎控制时间的差异。结果双C组和MSII组患者治疗后空腹血糖分别为（6．3±0．2）mmol／L和（6．8±1．2）mmol／L，餐后2h血糖分别为（8．7±0．4）mmol／L和（9．3±1．2）mmol／L，均能达标。治疗后双C组患者果糖胺（7．2±0．13）mmol／L与MSII组（9．0±0．11）mmol／L比较，差异有统计学意义（P〈0．01）。双C组患者肺炎主要症状（发热、胸痛、咳黄痰、剧烈咳嗽、呼吸困难和湿啰音）缓解时间分别为（4．2±1．8）d、（3．7±1．2）d、（d．7±1．8）d、（8．2±1．3）d、（8．3±1．1）d和（9．2±2．6）d，血糖达标时间为（3．7±0．6）d、肺炎控制时间（12．8±4．5）d、胰岛素用量（37．6±6．5）次／d及低血糖发生频率（0．6±0．4）次／例；MSII组分别为（6．2±1．7）d、（4．3±1．4）d、（8．4±2．5）d、（9．6±3．5）d、（9．6±3．4）d、（12．4±4．1）d、（7．2±1．2）d、（18．2±6．8）d、（57．2±10．3）U／d和（4．3±0．7）次／例，两组比较差异均有统计学意义（P〈0．05）。结论在配合抗生素的前提下，“双C”方案治疗能及时、有效地控制T2DM合并CAP患者的血糖水平．肺炎症状缓解时间及治愈肺炎的时间均较MSII组短，而且胰岛素用量少，低血糖发生率低，是理想的治疗方法。

Research of Different Insulin Dosage Way in Treatment of Type-2 Diabetic Patients with Community Acquired Pneumonia

Objective To evaluate the efficacy and safety of continuous subcutaneous insulin injection （DOUBLE C） and multiple insulin （MSII） in treatment of type 2 diabetic patients with community-acquired pneumonia （CAP）. Methods During the period from October 2004 to October 2009, 99 type 2 diabetic patients with CAP in our hospital were divided into group ＂DOUBLE C＂（50 cases） and group MSII （49 cases） at randomly, these patients has never used insulin before, to observe the days of controling all symptoms of pneumonia, blood glucose up to scratch and cure of pneumonia, the requirement of insulin, rates of hypoglycaemia between the two groups after insulin and antibiotics therapy. Results Blood glucose levels of all patients in two groups were up to standards. After the treatment the levels of fructosamine（7.2±0.13）mmol/L reduced significantly, and the level of fasting C-peptide（6.5±0.4）μg/L in creased remarkably in group ＂DOUBLE C＂, compared with group MSII （9.0± 0.11）mmol/L, （4.2±0.6）μg/L, respectively （P〈0.01）. The days of controling all symptoms of pneumonia, blood glucose up to scratch and cure of pneumonia were significantly shorter in group ＂DOUBLE C＂（P〈0.05）, while the requirement of insulin and rates of hypoglycaemia were lower in group ＂DOUBLE C＂ （P〈0.01）, there were statistical differences between group ＂DOUBLE C＂ and group MSII. Conclusion ＂DOUBLE C＂ in conjugation with antibiotics is able to control blood glucose, all symptoms of pneumonia and days of cure of pneumonia in time and effectually. The method has low expenditure of insulin and rates of hypoglycaemia, which is a better method for type 2 diabetic patients with CAP.