罗格列酮干预糖耐量减低疗效观察

目的 观察胰岛素增敏剂罗格列酮干预糖耐量减低(IGT)的效果.方法 采用随机对照试验,试验组(80例)给予强化生活方式干预(饮食控制、运动)+罗格列酮4 mg,对照组(60例)给予强化生活方式干预(饮食控制、运动),疗程均为24周.结果 试验组空腹血糖(4.6±0.8)mmol/L及餐后2 h血糖(7.6±1.2)mmol/L,比基础值(5.7±0.9)mmol/L及(9.6±1.8)mmol/L分别下降(P均＜0.01);试验组尿微量白蛋白排泄率(246±16)mg/24 h、胰岛素抵抗指数(2.024±0.427)、甘油三酯(1.6±0.8)mmol/L、空腹血糖(4.6±0.8)mmol/L及餐后2 h血糖(7.6±1.2)mmol/L下降明显大于对照组分别为(280±12)mg/24h,3.328±0.462,(2.5±0.9)、(5.5±0.7)、(8.9±1.3)mmol/L,P均＜0.01];明显改善外周组织对胰岛素的敏感性,治疗后胰岛素敏感性指数增加,由80±1至198±8(P＜0.01);能降低空腹胰岛素(FINS)由(32±9)mU/L至(21±8)mU/L]及C肽水平由(3.58±1.60)g/L至(2.52±1.20)g/L(P均＜0.01);血压于24周时降低,与对照组相比差异均有统计学意义收缩压(129±18)mm Hg与(135±17)mm Hg](P＜0.05).48周时试验组1例发展为2型糖尿病,对照组8例发展为2型糖尿病,2组差异有统计学意义(P＜0.05).罗格列酮不良反应发生率与对照组接近,未见肝功能损害等严重不良反应.结论 胰岛素增敏剂罗格列酮降血糖疗效确切,能降低IGT患者的空腹胰岛素及C肽水平,改善外周组织对胰岛素的敏感性,能阻止或延缓IGT发展为2型糖尿病.

Effects and side effects of rosiglitazone on impaired glucose tolerance

Objective To observe the effect of insulin increasing-sensitivity agent- rosiglitazone on impaired glucose tolerance. Methods One hundred and forty cases of impaired glucose tolerence(IGT)were divided into two groups randomly. Eighty cases was intervented with physical activity, diet control and rosiglitazone in the treatment group ,60 cases were intervened with physical activity and diet control in the control group for 24 weeks. Clinical characteristics, including BMI, blood pressure, blood glucose, lipids profiles, insulin, C-peptide and urinary microalbumin excretion were compared between two groups. Results In the treatment group, fasting glucose and 2 h glucose significantly decreased from (5.7 ±0.9) mmol/L and (9. 6 ± 1.8) mmol/L at the baseline to (4.6 ±0.8)mmol/L and (7. 6 ± 1.2) mmol/L(P ＜0.01). In the treatment group,the urinary micro-albumin excretion,insulin resistance,triglyceride, fasting glucose and 2 h glucose were (246 ± 16)mg/24 h,2. 024 ± 0.427, (1.6 ± 0.8)mmol/L, (4. 6 ± 0.8) mmol/L and (7. 6 ± 1.2) mmol/L, which was significantly lower than those of (280 ± 12)mg/24 h ,3. 328 ± 0.462, (2. 5 ± 0.9) mmol/L, (5.5 ± 0.7) mmol/L and (8. 9 ± 1.3) mmol/L in the control group (P ＜0.01). The treatment significantly improved the insulin sensitivity from 80 ± 1 at the baseline to 198 ±8. In the treatment, the FINS and C-peptide were significantly decreased from (32 ± 9) mU/L and (3. 58 ± 1.60) g/L at the baseline to (21 ± 8) mU/L and (2. 52 ± 1.20) g/L(P ＜ 0.01). The blood pressure deceased significantly at the 24th week, and signfiantly different from those in the conrol group (P ＜ 0.05). After 48 weeks, 1 of the patients in the treatment group developed into type 2 diabetes mellitus,whereas 8 patients developed into type 2 diabetes mellitus in the control group,which was significantly higher than that in the treatment group (P ＜0.05). The rate of side effects in the treatment group was similar with that in the control group, no liver function impair etc has been observed. Conclusions Rosiglitazone has significant effect on decreasing the blood sugar and decreasing the fasting insulin and C-peptide in patients with impaired glucose tolerancem improving the insuhn sensitivity of the circumference tissue, and can prevent or postpone the progression of IGT to type 2 diabetes mellitus in patients at risk of developing the disease.