糖尿病与大血管病

　　【摘要】 目的 观察长期胰岛素强化治疗对新诊断未伴明显动脉粥样硬化(AS)的T2DM患者炎症因子和颈动脉内膜中层厚度(IMT)的影响。 方法 30例新诊断T2DM患者胰岛素强化治疗6年，每年检测血清炎症因子高敏C 反应蛋白(hsC-RP)、TNF-α、可溶性细胞间黏附分子1(ICAM-1)水平及IMT。 结果 随访期间研究对象胰岛素日用量<30 U，体重、hsC-RP、TNF-α、ICAM-1和胰岛素抵抗指数(HOMA-IR)均先降低后升高。相关性分析显示，IMT与体重、HbA1c、hsC-RP、TNF-α、ICAM-1和HOMA-IR呈正相关(P<0.05或P<0.01)。 结论 新诊断未伴明显AS的T2DM患者采用生理剂量胰岛素强化治疗，短期内可减轻慢性炎症，阻止AS发生发展，长期获益还有待研究。

　　【关键词】 糖尿病，2型;胰岛素强化治疗;炎症因子;劲动脉内膜中层厚度

　　【Abstract】 Obejective To investigate effect of six-year intensive insulin therapy on serum levels of inflammatory factors and carotid intima-media thickness (IMT) in patients with newly diagnosed T2DM without obvious atherosclerosis. Methods Intensive insulin therapy was administered in total thirty patients with newly diagnosed T2DM. The follow-up lasted for six years. Serum levels of high sensitive C-reactive protein (hsC-RP), TNF-α and intercellular adhesion molecule-1 (ICAM-1) were all detected every year. Results During the six-year follow-up period, the mean daily dose of insulin was no more than 30 U, and the values of IMT, body weight, serum levels of hsC-RP, TNF-α, ICAM-1 and HOMA-IR all varied from the declination at first to the raise at last. Correlation analysis showed that there were positive correlations of IMT with body weight, HbA1c, hsC-RP, TNF-α,ICAM-1 and HOMA-IR(P<0.05 or P<0.01). Conclusion Intensive insulin therapy with physiological dose in patients with newly diagnosed T2DM without obvious atherosclerosis could relieve the degree of inflammatory conditions and keep atherosclerosis away from developing during short term. On long terms, the above benefits would be not clear.

　　【Key words】 Diabetes mellitus，type 2;Intensive insulin therapy;Inflammatory factors;Carotid intima-media thickness (IMT)