实时动态胰岛素泵系统治疗 AECOPD合并2型糖尿病的疗效观察

目的：探讨实时动态胰岛素泵系统（RT-CGMS＋CSⅡ＋Carelink，3C）治疗慢性阻塞性肺疾病急性加重期（AECOPD）合并2型糖尿病（ T2 DM）的临床疗效。方法 AECOPD合并T2 DM患者90例，全部停用口服降糖药物，在AECOPD常规治疗的基础上，随机等分为CSⅡ模式、双C（ CGMS＋CSⅡ）模式和3C模式组进行降糖治疗。观察3组治疗后炎症反应和氧化应激水平变化、血糖达标时间，达标时每日胰岛素用量、低血糖发生率以及AECOPD有效性和住院时间。结果3组血糖达标所需时间3C组＜双C组＜CSlI组（P＜0．05），达标时每日所需胰岛素用量3C组＜双C组＜CSⅡ组（P＜0．05-0．01）；低血糖发生率3C组＜双C组＜CSⅡ组（P＜0．01），3组患者AECOPD治疗效果有明显差异（P＜0．01），其中3C组疗效最佳（P＜0．05～0．01）。总住院时间3C组＜双C组＜CSⅡ组（P＜0．05）。3组血糖达标后，高敏C反应蛋白（hs-CRP）、肿瘤坏死因子-α（TNF-α）及丙二醛（MDA）水平较治疗前均有明显下降，超氧化物歧化酶（SOD）水平明显升高（P＜0．05），但3C组hs-CRP、TNF-α和MDA下降及SOD升高水平较其它两组更明显（P＜0．05～0．01）。结论实时动态胰岛素泵系统治疗AECOPD合并T2DM，能更安全有效控制血糖，减轻炎症反应和氧化应激，缩短住院时间，提高AECOPD治疗有效率。

Efficacy of real-time continuous insulin pump system in patients with acute exacerbation of chronic obstructive pulmonary disease combined with type 2 diabetes mellitus

Objective To observe the efficacy of real-time continuous insulin pump system （3C） in patients with chronic obstructive pulmonary disease with acute exacerbation （ AECOPD） combined with type 2 diabetes mellitus .Methods Ninety patients with AECO-PD and type 2 diabetes mellitus were selected and stopped using oral hypoglycernic agents .Based on the routine therapy for AECOPD , they were randomly assigned into three groups：the continuous subcutaneous insulin infusion （CS） group（n=30）,continuous glucose monitoring system（CGMS） plus CSⅡgroup（n=30） and 3C group（n=30）.The glucose target time,dosage of insulin,frequency of hypoglycemic incidence rates ,the degree of inflammatory reaction ,the levels of oxidative stress and the treatment efficiency and hospital stay of AECOPD were observed and compared among three groups .Results The glucose target time,dosage of insulin,frequency of hypoglycemic incidence rates and hospital stay of AECOPD in 3C group and CGMS plus CSⅡgroup had decreased more than in CSⅡgroup.And the difference of treatment efficiency of AECOPD was significant in three groups （P＆lt;0.01）,especially in 3C group（P＆lt;0.05~0.01）.Moreover,these changes in 3C group were larger than in CGMS plus CSⅡ group（P＆lt;0.05 or 0.01）.The level differ-ences of hsC-RP,TNF-αMDA and SOD among three groups were not obvious at pretherapy .But the levels of hsC-RP,TNF-αMDA de-creased more obviously after glucose arrived target than pretherapy ,and the change of SOD level was properly opposite （P＆lt;0.05）.The decrease of hs-CRP,TNF-αand MDA,and the rise of SOD of 3C group were more significant than the other two groups （P＆lt;0.05 or 0.01）.Conclusions The real-time continuous insulin pump system（3C） is safer and more effective than the other two groups in treat-ment of patients with AECOPD combined with type 2 diabetes mellitus .