沙格列汀片治療繼發(fā)性口服藥物失效老年2型糖尿病的臨床研究

李志杰+張文書+張國平

【摘要】 目的：觀察沙格列汀片口服對繼發(fā)性口服藥物失效的老年2型糖尿病（T2DM）患者的療效。方法：選取2012年3月-2014年3月本院收治的繼發(fā)口服藥物失效的60例老年T2DM患者，按照隨機數(shù)字表法將其分為A、B組各30例。A組給予口服沙格列汀片，1次/d，B組給予諾和靈30R皮下注射，早、晚各1次，療程12周，觀察比較兩組患者治療前后空腹血糖（FBG）、餐后2 h血糖（P2 hBG）、糖化血紅蛋白（HbA1c）、血脂（TG）、體質指數(shù)（BMI）的變化。結果：2組均有較好的治療效果，經12周治療后兩組患者的FBG、P2 hBG、HbA1c和TG均明顯低于治療前，差異均有統(tǒng)計學意義（P<0.01或P<0.05），而兩組治療前后的BMI比較差異無統(tǒng)計學意義（P>0.05）。結論：繼發(fā)性口服藥物失效的老年T2DM患者經口服沙格列汀片及皮下注射諾和靈30R治療，均有較好的治療效果，但老年患者口服藥物治療更加方便，服藥時間不受進餐影響，遵醫(yī)依從性更好。

【關鍵詞】 沙格列汀片； 繼發(fā)性口服降糖藥物失效； 老年2型糖尿病

The Clinical Study of Saxagliptin Tablet in Treatment of Elderly Patients with Type 2 Diabetes of Secondary Failure of Oral Drug/LI Zhi-jie，ZHANG Wen-shu，ZHANG Guo-ping.//Medical Innovation of China，2014，11（28）：105-107

【Abstract】 Objective：To observe the curative effect of saxagliptin tablets in treatment of elderly patients with type 2 diabetes mellitus （T2DM） of secondary failure to oral drug.Method：60 elderly patients with T2DM of secondary failure to oral drugs were selected in our hospital from March 2012 to March 2014，they were divided into the group A and the group B according to the random number table method，30 cases in each group.The group A took saxagliptin tablets once a day，and the group B were injected subcutaneously Novolin 30R twice a day for 12 weeks.The fasting blood glucose，2 h postprandial blood glucose levels and HbA1c，triglyceride level，body mass of the two groups before and after treatment were observed and compared.Result：Both group A and B had good effect，the fasting blood glucose，2 h postprandial blood glucose，glycosylated hemoglobin，triglyceride levels of the two groups after 12 weeks of treatment were significantly lower than before treatment，the differences were statistically significant（P<0.05），there was no statistically significant difference in body mass between the two groups before and after treatment（P>0.05）.Conclusion：In patients with T2DM on secondary oral drug failure，both taking saxagliptin tablets and injecting Novolin 30R subcutaneously have good treatment effect，but oral drug therapy is more convenient，and not restricted by meals，thus the patients compliance is better.

【Key words】 Saxagliptin tablet； Secondary oral drug failure； Elderly patient with type 2 diabetes mellitus

First-authors address：The Peoples Hospital of Handan City，Handan 056001，China

doi：10.3969/j.issn.1674-4985.2014.28.036

隨著生活方式的改變及人口日益老齡化等因素的影響，我國老年T2DM的發(fā)病率迅速增加，目前≥60歲的老年DM發(fā)病率>20%，還有約25%糖耐量異常患者[1]。繼發(fā)治療失效是指先前能有效控制血糖，治療后1～3年藥物足量而失效者[2]。在老年T2DM患者中，繼發(fā)性口服藥物失效的發(fā)生率為每年5%～10%，老年T2DM患者的特點是病程長，胰島功能差且易發(fā)生低血糖[3]。臨床上，磺脲類藥物及雙胍類通過促進β細胞分泌胰島素及促進周圍組織細胞（肌肉等）對葡萄糖的利用和抑制肝糖原異生作用來降低血糖，但隨著病情的發(fā)展，對老年T2DM患者的血糖控制減弱，導致繼發(fā)性口服降糖藥物失效，成為老年T2DM血糖控制欠佳的臨床難題。現(xiàn)……