胰岛素泵强化治疗对老年女性早期糖尿病肾病的影响

目的观察不同胰岛素制剂及应用方法对老年女性早期糖尿病肾病(DN)尿蛋白的影响。方法将47例老年女性早期DN患者随机分治疗组和对照组,对照组应用普通胰岛素三餐前皮下注射控制血糖,治疗组予门冬胰岛素胰岛素泵持续皮下注射控制血糖,4周后观察疗效,比较两组治疗前后24h尿微量白蛋白排泄率(UAER)、β2微球蛋白(β2-MG)及内生肌酐清除率(Ccr)的变化及各时间点血糖变化。结果两组治疗后UAER及β2-MG较治疗前均有下降(P<0.05),治疗组较对照组下降更为明显(P<0.05);两组治疗前后Ccr差异无显著性;治疗后4周,观察到除了凌晨3点两组血糖比较差异无显著性外,两组各时间点的血糖均较治疗前显著下降,差异均有显著性(P<0.05)。结论胰岛素强化治疗能降低老年女性早期DN患者尿微量白蛋白及β2-MG,而胰岛素泵应用效果更为理想。

Results of insulin bump intensive treatment for elderly female patients with early diabetic nephropathy

Objective To observe the effects of different insulin medication on female elderly patients with early diabetic nephropathy(DN).Methods 47 female elderly patients with early diabetic nephropathy were randomly divided into treated group and control group.In treated group: patients were treated with continuous subcutaneous insulin injection(CSII) by bumpig into insulin aspart.In control group,patients were treated with multiple subcutaneous insulin injection(MSII) of normal insulin for a cycle of four weeks,then the urine albumin secretion rate(UAER),the β2 microglobuin(β2-MG),creatinine clearance(Ccr) in 24 hours and blood glucose levels at every time points of the two groups were determined before and after treatment.Results After treatment,the UAER and β2-MG in both of the two groups decreased significantly,compared to before treatment(P<0.05),while compared to the control group,the treated group decreased more significantly in UAER and β2-MG(P<0.05).But there was no significant difference in comparison of Ccr levels before and after treatment.4 weeks after treatment,except that the comparison of the blood glucose at 3:00 am between the two groups resulted in the same,the blood glucose at every time points decreased significantly comparing to before treatment,there were statistically significant differences(P<0.05).Conclusion Insulin intensive treatment can decrease the urine microalbumine and β2-MG in female elderly patients with early diabetic nephropathy and CSII can get a more satisfactory result.