阿卡波糖在T2DM治疗中的地位.ppt

* 研究过程中一直给予生长抑素抑制自身胰岛素的分泌，同时给予外源胰岛素维持血糖水平 Nitrotyrosine :硝基酪氨酸 FMD: 血流介导的血管舒张反应 Background: Several epidemiological studies have shown that postprandial hyperglycemia is associated with an increased risk of cardiovascular disease (CVD). The present study was conducted in order to compare the effects of acarbose and glimepiride treatment on serum lipoprotein profiles in patients with type 2 diabetes. Methods: A total of 37 patients with newly diagnosed type 2 diabetes were studied. The patients were assigned randomly to treatment for 12 weeks with either acarbose (n=13, 100 mg×3/day, group A), glimepiride (n=13, 2 mg/day, group G) or diet only (n=11, group D). Lipid and lipoprotein profiles before and after each treatment were evaluated. Results: A significant reduction in the net electronegative charge of low-density lipoprotein (emLDL) was observed in group A (?1.8, Pb0.01), whereas no significant change in emLDL was observed in groups G and D. In group A, small VLDL and very small LDL levels were also decreased significantly (P0.05). The change in emLDL levels correlated significantly with changes in very small LDL (r=0.751, P0.01) and oxidized LDL levels (r=0.623, P0.05). Conclusion: These results suggest that measurement of serum emLDL may be a sensitive and clinically useful marker for determining qualitative lipoprotein abnormalities in diabetes, and that acarbose treatment lowers CVD risk by decreasing production of emLDL * * * 目的：比较T2DM患者在使用磺脲+双胍的基础上，加用那格列奈或阿卡波糖对代谢的作用。研究主要终点为何种治疗方案降低PPG更有效，次要终点为评估何种治疗方案对入选患者全面血糖管理更为有效。 试验设计和方法：共纳入患者103例，导入期4周，联用磺脲+双胍。随机分入瑞格列奈组，6mg/d（2mg，tid）或阿卡波糖组300mg/d（100mg/d） 强制滴定15周（不依赖于患者的血糖控制，除因剂量引起的副作用），随后交叉治疗12周。分别于基线、1、2、15和27w评估患者BMI、FPG、PPG、空腹胰岛素（FPI）、餐后胰岛素（PPI）水平。 结果：7位患者未完成试验，其中1例失访，6例因药物不良反应退出试验（1周2例、15周1例、交叉治疗后3例）。不良反应包括恶心（阿卡波糖组1例）、胃肠道事件（阿卡波糖组4例）以及低血糖（瑞格列奈组1例）。瑞格列奈治疗15周HbA(1c) (-1.1%, p 0.05)、FPG (-9.5%, p 0.05)及 PPG (-14.9%, p 0.05)较基线值显著降低， 体重 (+2.3%, p 0.05), BMI (+3.3%, p 0.05) 及 FPI (+22.5%, p 0.05)均显著增加，并随交叉治疗而变化