王菲菲 张玲 包玉倩

[摘要] 目的 研究二甲双胍与格列吡嗪单药治疗对胰岛素分泌功能的影响。 方法 筛选2007～2012年门诊新诊断2型糖尿病患者160例，分为二甲双胍组（81例）和格列吡嗪组（79例），分别采用二甲双胍和格列吡嗪单药治疗，分别观察两组治疗后血糖水平及胰岛素分泌指标的变化情况。 结果 两组用药后空腹血糖、餐后2 h血糖和糖化血红蛋白均较基线时明显降低（P均<0.01）。二甲双胍组用药后HOMA-β%较基线时明显升高（P<0.01），而HOMA-IR和ΔPI均较基线时明显降低（P均<0.01）；精氨酸刺激后各时点PI值用药后均较基线时明显降低（P<0.01）。格列吡嗪组用药后HOMA-β%和ΔTI较基线时明显升高（P<0.01）。 结论 二甲双胍与格列吡嗪单药治疗均能较好控制2型糖尿病患者的血糖水平。二甲双胍不仅减轻机体胰岛素抵抗程度，而且增加基础胰岛素分泌功能，提高胰岛素质量。格列吡嗪可改善基础胰岛素分泌及早相胰岛素分泌功能。

[关键词] 二甲双胍；格列吡嗪；2型糖尿病；胰岛素分泌；胰岛素抵抗

[中图分类号] R587.1 [文献标识码] A [文章编号] 1673-9701（2015）34-0007-04

The effect of metformin and glipizide monotherapy on insulin secretion function in newly diagnosed type 2 diabetes

WANG Feifei1 ZHANG Ling1 BAO Yuqian2

1.Department of Endocrinology and Metabolism，Huzhou First Peoples Hospital， the Affiliated Hospital of Huzhou Teachers College，Huzhou 313000，China；2.Department of Endorinology and Metabolism，Shanghai Jiaotong University Affiliated Sixth Peoples Hospital，Shanghai 200233，China

[Abstract] Objective To evaluate the effect of metformin and glipizide monotherapy on insulin secretion. Methods One hundred and sixty newly diagnosed type 2 diabetic patients who came to the outpatient department from 2007 to 2012 were divided into two groups named metformin group（n=81） and glipizide group（n=79）， which were treated with metformin and glipizide respectively. The variation of blood glucose levels and insulin secretion indexes after treatment were observed. Results Compared with baseline， fasting plasma glucose， 2 h postprandial plasma glucose and glycated hemoglobin were all significantly decreased after treatment in both groups（all P<0.01）. After treatment with metformin， HOMA-β% was significantly increased compared with baseline（P<0.01）， whereas HOMA-IR and the incremental value of serum proinsulin （ΔPI） were significantly decreased（all P<0.01）. Proinsulin at different times after arginine stimulation were all significantly decreased compared with baseline（P<0.01）. After treatment with glipizide， HOMA-β% and ΔPI were significantly increased compared with baseline （P<0.01）. Conclusion Blood glucose level can be effectively controlled by both metformin and glipizide monotherapy. Metformin could not only reduce insulin resistance，but also improve basal insulin secretion and the quality of insulin at the same time. Glipizide could both improve basal insulin secretion and early-phase insulin secretion function.

[Key words] Metformin；Glipizide；Type 2 diabetes；Insulin secretion；Insulin resistence

目前，糖尿病已成为严重威胁人类健康的世界性难题[1]。随着我国经济的日益增长、城市化进程的加快，糖尿病患病率正逐年上升，且发病年龄呈现低龄化趋势，最新研究结果显示中国成人糖尿病患病率接近11.6%[2，3]。在不同类型的糖尿病中，2型糖尿病占90%以上，此类患者大多起病隐匿，因此，相当一部分患者在初次诊断为糖尿病时血糖已处于较高水平，单纯的饮食控制和运动治疗已不能使血糖达标，常须通过口服降糖药来控制血糖。本研究旨在评价临床上常用的二甲双胍和格列吡嗪单药治疗对新诊断2型糖尿病患者胰岛素分泌功能和胰岛素抵抗的影响。

1 资料与方法

1.1 一般资料

选取2007年6月～2012年12月期间至上海市第六人民医院门诊就诊的160例新诊断的2型糖尿病患者，年龄30～70岁，平均（51.0±10.5）岁，其中男85例，女75例。入选条件为新诊断而未经治疗的2型糖尿病患者，糖化血红蛋白（Glycated hemoglobin， HbA1c）≥6.5%，体重指数（body mass index，BMI）≥18.5 kg/m2。排除明显的肝肾疾病、严重的心血管疾病及肿瘤等疾病，未使用影响胰岛素分泌和敏感性的药物。……