目的 針對近期收治的1 例少見胰島素自身抗體（insulin autoantibody，IAA）所致頻發(fā)嚴(yán)重低血糖的糖尿病患者，檢索當(dāng)前最佳證據(jù)，為臨床合理治療提供依據(jù)。方法 計(jì)算機(jī)檢索Cochrane 圖書館（2008 年第3 期）、PubMed（1966 ～ 2009.7）、EMbase（1974 ～ 2009.7）、CBM（1978 ～ 2009.7）、CNKI（1976 ～ 2009.7），按證據(jù)級別高低查找相關(guān)證據(jù)，并對所獲證據(jù)進(jìn)行評價(jià)。結(jié)果 共檢索到291 篇文獻(xiàn)，無臨床指南和系統(tǒng)評價(jià)，也無臨床對照研究。有關(guān)臨床治療的文獻(xiàn)共有30 篇，共包括6 種治療措施，其中胰島素聯(lián)合類固醇類藥物效果相對較好，副作用發(fā)生較低。根據(jù)患者意愿和我院實(shí)際情況，在應(yīng)用胰島素控制血糖的基礎(chǔ)上，對該患者短期給予糖皮質(zhì)激素（強(qiáng)的松）治療，17 天后IAA 滴度從13.3% 降至5.41%，24 天后降至0.62%，血糖水平趨于穩(wěn)定，未見低血糖發(fā)生。隨訪5 個(gè)月，病情穩(wěn)定，血糖控制尚可，未見低血糖發(fā)作。結(jié)論 短期給予糖皮質(zhì)激素治療是治療IAA 所致頻發(fā)嚴(yán)重低血糖的有效方法。
【摘要】 目的 探討胰島素強(qiáng)化治療對2型糖尿?。╰ype 2 diabetes mellitus，T2DM）患者血清脂聯(lián)素（adiponectin，APN）的影響?！》椒ā?007年7—12月，研究納入連續(xù)使用胰島素治療至少3個(gè)月但血糖控制欠佳[6.5%≤糖化血紅蛋白（hemoglobin A1c， HbA1c）≤11.0%]的T2DM患者40例，其中男18例，女22例；年齡29~〖JP2〗69歲；平均診斷T2DM病史11年。治療方案為進(jìn)行16周的胰島素強(qiáng)化治療，血糖控制目標(biāo)為空腹血糖≤7 mmol/L，〖JP〗餐后2 h血糖≤8 mmol/L。分別于強(qiáng)化治療前、強(qiáng)化治療4周后及強(qiáng)化治療16周后測定HbA1c以及血清APN水平?！〗Y(jié)果 與強(qiáng)化治療前相比，胰島素治療4周后空腹及三餐后2 h血糖明顯下降（Plt;0.05），但HbA1c和血清APN水平差異無統(tǒng)計(jì)學(xué)意義（Pgt;0.05）；強(qiáng)化16周后，HbA1c水平明顯低于治療前和治療4周后且差異具有統(tǒng)計(jì)學(xué)意義（Plt;0.05），APN水平高于治療前和治療4周后且差異有統(tǒng)計(jì)學(xué)意義（Plt;0.05）。體質(zhì)量指數(shù)在強(qiáng)化治療16周后明顯增加且與強(qiáng)化治療前和強(qiáng)化治療后4周相比差異具有統(tǒng)計(jì)學(xué)意義（Plt;0.05）。APN與空腹血糖（b=-0.225，P=0.013）、早餐后2 h血糖（b=-0.229，P=0.012）呈負(fù)相關(guān)?！〗Y(jié)論 胰島素強(qiáng)化治療可以提高T2DM患者血清APN水平。【Abstract】 Objective To investigate the effect of intensive insulin therapy on serum adiponectin (APN) level in patients with type 2 diabetes mellitus (T2DM). Methods Forty patients with T2DM who had undergone insulin therapy for at least three months but with their blood glucose poorly controlled [glycosylated hemoglobin Alc (HbA1c) level ranged from 6.5% to 10.0%] from July to December 2007 were enrolled in this study. There were 18 males and 22 females with their age ranged from 29 to 69 years. They had an average time of T2DM history of 11 years. Intensive insulin therapy was carried out for 16 weeks with a target of less than 7 mmol/L for fasting blood glucose and 8 mmol/L for postprandial blood glucose. HbA1c and serum adiponectin concentrations were detected at baseline, at week 4 after intensive therapy and at the end of the study. Results After 4 weeks of intensive blood glucose control, fasting and postprandial blood glucose levels decreased significantly (Plt;0.05), but the HbA1c and serum APN concentrations did not reduce remarkably (Pgt;0.05). After 16 weeks of treatment, the level of HbA1c was significantly lower than those at baseline and 4 weeks after treatment (Plt;0.05), and serum APN concentration increased significantly (Plt;0.05), compared with those two time points. However, an evident increase of body mass index (BMI) was found while compared with BMI at baseline and 4 weeks after treatment (Plt;0.05). The linear regression analysis indicated that APN was negatively associated with fasting blood glucose (b=-0.225,P=0.013) and blood glucose level 2 hours after breakfast (b=-0.229,P=0.012). Conclusion Intensive insulin therapy can improve serum adiponectin level in type-2 diabetic patients.