甘精胰岛素治疗2型糖尿病合并食管癌围手术期疗效观察

摘要

目的 观察甘精胰岛素对2型糖尿病合并食管癌围手术期疗效.方法 选择81例食管癌的患者,其中2型糖尿病患者51例:随机分为2组:(1)甘精胰岛素组(25例);(2)胰岛素泵组(26例);无糖尿病患者30例为对照组.于治疗前后检测观察3组血糖控制时间、治疗后日平均血糖、血糖波动程度、胰岛素日使用量、低血糖的发生率、降血糖平均日费用情况、空腹C肽及C-反应蛋白水平.采用C肽评估胰岛素抵抗指数.结果 (1)甘精胰岛素组在血糖控制时间、治疗后日平均血糖、胰岛素日使用量、低血糖的发生率、血糖波动程度、改善胰岛素抵抗等方面与胰岛素泵组无差异,甘精胰岛素组在降血糖的日均费用上显著低于胰岛素泵组(P<0.05).(2)治疗后三组C反应蛋白水平较治疗前均有升高,但三组之间无差别(P>0.05).结论 2型糖尿病患者在围术期采用甘精胰岛素不仅可以快速、有效、安全地控制血糖,更能改善术后胰岛素抵抗,进而减少了各种术后糖尿病急性并发症的发生,促进切口愈合.%Objective To investigate the clinical efficacy of glargine on insulin resistance in type 2 diabetic patients with esophageal cancer during the perioperative period. Methods Fifty-one cases of perioperative patients with type 2 diabetes and esophageal cancer were divided randomly into two groups, one group receiving injection of glargine, another group receiving pump and basic dose of insulin. Thirty cases of perioperative patients with esophageal cancer and without type 2 diabetes were chosen as controls. Blood glucose controlled time,the average blood glucose,blood glcose fluctuations,insulin dosage per day,fasting C peptide levels,the incidence of hypoglycemia, the average daily cost and C reactive protein( CRP )were compared among three groups after treatment. Homeostasis model assessment ( HOMA ) method was used for index of insulin resistance. Results ( 1 )The blood glucose controlled time, the average blood glucose, insulin dosage per day, incidence of hypoglycemia homeostasis model assessment HOMA ) for insulin resistance and blood glucose fluctuations in glargine group had no significant difference when compared with those in insulin pumps group( P > 0.05 ). The average daily cost in glargine group was significantly lower than that in insulin pumps group( P <0. 05 ). ( 2 ) After treatment, C-reactive protein levels in all three groups were increased compared with before treatment, but there was no difference among the three groups( P >0. 05 ). Conclusion The application of glargine in type 2 diabetic patients with esophageal cancer can not only quickly, effectively and safely control glucose, but also improve the postoperative insulin resistance, thereby reduce the variety of postoperative acute complications of diabetes.