单用二甲双胍血糖控制不佳时联合西格列汀治疗的临床效果

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摘要

目的探讨单用二甲双胍血糖控制不佳时联合西格列汀治疗的临床效果。方法选取2017年1月～2019年10月在我院就诊的105 例2 型糖尿病患者作为研究对象，有5 例脱落，最终入组100 例，采用随机数字表法将其分为三组，即单纯二甲双胍组（A 组）30 例、二甲双胍+阿卡波糖组（B 组）35 例、二甲双胍+西格列汀组（C 组）35例。比较三组患者治疗前后糖化血红蛋白（HbA1c）、1,5-脱水葡萄糖醇（1,5-AG）、丙二醛（MDA）、基质细胞衍生因子-1α（SDF-1α），并记录三组的不良反应发生情况。结果治疗后，B 组、C 组患者的HbA1c、MDA 均低于A 组，差异有统计学意义（P<0.01）；B 组和C 组患者治疗后的HbA1c、MDA 比较，差异无统计学意义（P>0.05）。B 组和C 组患者的1,5-AG 在治疗后的不同访视期均高于A 组，差异有统计学意义（P<0.05）；C 组患者的1,5-AG 在访视2 期和访视3 期均高于B 组，差异有统计学意义（P<0.05）。A 组和B 组患者治疗前后的SDF-1α 比较，差异无统计学意义（P>0.05）；C 组患者治疗后的SDF-1α 高于本组治疗前及A 组和B 组，差异有统计学意义（P<0.01）。A组和C 组患者的不良反应总发生率低于B 组，差异有统计学意义（P<0.05）。结论二甲双胍单药血糖控制不佳时，联合西格列汀和阿卡波糖治疗，降HbA1c 的程度两者相当；但联合西格列汀治疗的患者血糖波动更小，能减轻体内的氧化应激和细胞受损，可改善动脉粥样硬化，是一种更佳的降糖方案。

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关键词 ：糖化血红蛋白, 血糖波动, 1, 5-脱水葡萄糖醇, 丙二醛, 基质细胞衍生因子-1&alpha

Abstract：

Objective To explore the clinical effect of combined treatment with Sitagliptin when blood glucose is poorly controlled with Metformin alone. Methods A total of 105 patients with type 2 diabetes mellitus who were treated in our hospital from January 2017 to October 2019 were selected as the research objects, 5 cases fell out and 100 cases were eventually enrolled. They were divided into three groups by the random number table method, namely Metformin alone group (group A, n=30), Metformin+Acarbose group (group B, n=35), and Metformin+Sitagliptin group (group C, n=35).The glycated hemoglobin (HbA1c), 1,5-anhydroglucose (1,5-AG), malondialdehyde (MDA), stromal cell-derived factor-1α (SDF-1α) before and after treatment were compared among the three groups, and the incidence of adverse reactions was recorded in the three groups. Results After treatment, the HbA1c and MDA in group B and C were lower than those in group A, and the differences were statistically significant (P<0.01). There were no significant differences in HbA1c and MDA between group B and group C after treatment (P>0.05). The 1,5-AG in group B and C was higher than that in group A at different visit periods after treatment, and the difference was statistically significant (P<0.05).The 1,5-AG in group C was higher than that in group B in visit period 2 and visit period 3, and the difference was statistically significant (P<0.05). There was no significant difference in SDF-1α in group A and group B before and after treatment (P>0.05). The SDF-1α in group C after treatment was higher than that before treatment and in group A and group B, and the difference was statistically significant (P<0.01). The total incidence of adverse reactions in group A and group C was lower than that in group B, and the difference was statistically significant (P<0.05). Conclusion When blood glucose is poorly controlled with Metformin alone, the combination of Sitagliptin or Acarbose both can reduce the level of HbA1c in a tantamount effect; however, the combination of Sitagliptin has smaller blood glucose fluctuations and can reduce oxidative stress and cellular damage, and can improve atherosclerosis, which is an optimal glucoselowering program.

Key words： Glycated hemoglobin Blood glucose fluctuations 1,5-anhydroglucose Malondialdehyde Stromal cell-derived factor-1α

基金资助:江西省吉安市指导性科技计划项目[吉市科计字（2019）8 号56]

引用本文:

曾菊丽；罗贤；贺五风；刘晓慧；李琼；张莉芝. 单用二甲双胍血糖控制不佳时联合西格列汀治疗的临床效果[J]. 中国当代医药, 2020, 27(27): 64-68.
ZENG Ju-li LUO Xian HE Wu-feng LIU Xiao-hui LI Qiong ZHANG Li-zhi▲. Clinical effect of combined treatment with Sitagliptin when blood glucose is poorly controlled with Metformin alone. 中国当代医药, 2020, 27(27): 64-68.

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