胰岛素强化治疗2型糖尿病性脂肪肝

目的：探讨2型糖尿病性脂肪肝患者控制高血糖的最佳方法。方法：收集本院内分泌科32例2型糖尿病性脂肪肝患者自愿分为甘精胰岛素联合门冬胰岛素治疗组（GA组，n=16）与重组人胰岛素N联合门冬胰岛素治疗纽（NA组，n=16），观察每组病人治疗前后各项临床指标变化。结果：治疗后GA组和NA纽空腹血糖（5．25±0．64）mmol／L、6．51±1．23）mmol／L和餐后2h血糖（7．32±1．05）mmo]／L、（9．46±0．52）mm01／L、所需胰岛素剂量（36．8±0．7）Iu、（42．8±1．8）Iu、血糖波动状况[（1．92±0．87）、（2．95±0．83）mmol／L]、低血糖和黎明现象发生率及血糖达标时间等各项指标相比较，GA组明显低于NA组（P〈0．05），同时肝功能改善更明显。结论：胰岛素强化治疗是2型糖尿病性脂肪肝控制血糖的理想治疗方法，但甘精胰岛素联合门冬胰岛素治疗更有优势。

Clinical Observation for Intensive Insulin Therapy in Type 2 Diabetics with Fatty Liver

Objective：To investigate the optimal treatment of blood sugar control in type 2 diabetics with fatty liver. Methods：32 cases of type 2 diabetics with fatty liver were voluntarily divided into the Glargine and Aspart insulins treated group （group GA, n = 16） and rh-insulin plus aspart insulin treated group （group NA, n = 16）. The changes of clinical measures in each group were observed before and after treatment. Results ： The levels of fasting plasma glucose and 2 hours postprandial glucose, insulin dosage, blood glucose fluctuation in group GA [ （5.25 ± 0. 64） mmol/L, （7.32 ± 1.05 ） mmol/L, （36.8 ± 0.7 ） IU, （ 1.92 ± 0.87 ） mmol/L] were significantly lower than those in group NA [ （6.51 ±1.23） mmol/L, （9.46 ± 0.52） mmol/L, （42.8 ± 1.8） IU, （2.95± 0.83 ） mmol/L, all P 〈 0. 05 ]. Simultaneously,time to blood sugar control, incidence of hypoglycemia and dawn phenomenon in group GA were significantly shorter or lower than those in group NA （ all P 〈 0.05 ）. The liver function of group GA was improved earlier. Conclusion：Intensive insulin therapy might be the perfect choice for type 2 diabetic with fatty liver. Glargine and aspart insulins in combination may be advantageous over treatment with rh-insulin plus insulin aspart.