目的 观察不同方式胰岛素强化治疗对初诊2型糖尿病(T2DM)患者胰岛β细胞功能的影响.方法 根据胰岛素强化治疗过程中血糖控制达标速度的差异将患者分为快速血糖控制组(A组)和温和血糖控制组(B组),比较两组治疗过程中胰岛β细胞功能指数(HOMA-β)、胰岛素抵抗指数( HOMA-IR)、30分钟C-肽曲线下面积(AUCCP30)、120分钟C-肽曲线下面积( AUCCP120)的变化.结果 胰岛素强化治疗过程中,两组患者血糖水平均逐渐降至空腹血糖(FBG)≤6.5 mmol/L、餐后2小时血糖(2hPBG)≤9.0 mmol/L,治疗4周时两组患者HOMA-β由10.3±3.8、9.9±4.6分别升至50.5±33.9、45.7±13.5,HOMA-IR由3.4±3.7、4.0±1.2分别降至2.5±2.6、2.7±3.0,各组治疗4周后与治疗前比较差异有统计学意义(P＜0.05),两组间比较差异无统计学意义(P＞0.05).治疗4周时AUCCP30、AUCCP120由15.7±7.5、18.1±10.6分别增至20.7±3.6、21.6±5.4,差异有统计学意义(P＜0.05).结论 胰岛素强化治疗降糖效果明显,血糖控制良好可使胰岛β细胞功能及胰岛素抵抗得到改善,胰岛素早时相分泌与血糖控制的速度相关性不明显,与血糖下降的幅度相关.%Objective To observe the affect on islet p-ce11 function of newly diagnosed type 2 di-abetic(T2DM) patients with different intersive insulin treatment. Methods The newly diagnosed T2DM patients which received intersive insulin treatment for 4 weeks were divided into group A (getting excellent control of blood glucose in a week) and group B( getting excellent control of blood glucose in 2 weeks). HOMA-β、HOMA-IR、AUCcp30、AUCcp120 were measured and compared before and after treatment. Results During intersive insulin treatment,FBG and 2hPBG were controlled( FBG≤6. 5 mmol/L and 2hPBG≤9.0 mmol/L). HOMA-β increased from 10.3 ±3.8 and 9.9 ±4.6 to 50. 5 ±33.9 and 45.7 ± 13.5,HOMA-IR decreased from 3.4 ±3.7 and 4.0 ± 1.2 to 2.5 ±2.6 and 2.7 ±3.0. Two groups changes were significantly after treatment (P < 0. 05 ) , but there were no significant difference between the two groups ( P > 0.05 ). AUCcp30 and AUCcp120 of two groups were improved after intersive insulin treatment from 15.7 ±7.5 and 18. 1 ±10.6 to 20. 7 ±3.6 and 21.6±5.4(P<0.05). Conclusion Intersive insulin treatment can significantly improve glycemic,the islet β-cell function and insulin resistance of newly diagnosed type 2 diabetic patients. Early-phase of insulin secretion has no obvious correlation with the speed of blood glucose control, while relate with the magnitude of decline in glycemic.
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