Jankovec Zdenek, Cechurova Daniela, Krcma Michal, Lacigova Silvie, Zourek Michal, Rusavy Zdenek
Medical Department I, University Hospital, Plzen, Czech Republic.
Wien Klin Wochenschr. 2009;121(13-14):459-63. doi: 10.1007/s00508-009-1203-x.
The aim of our study was to evaluate the influence of long-term insulin pump treatment (CSII) on the parameters of metabolic syndrome in insulin-resistant patients with poorly controlled type 2 diabetes mellitus.
Thirteen obese (BMI>30) patients (8 women, 5 men), average age 58.8+/-9.06 years, treated with an intensified insulin regimen with high doses of insulin (>0.8 IU/kg per 24 h) for at least 12 months were enrolled in the study. Prior to CSII treatment, all patients were reeducated regarding diabetes treatment and metabolic syndrome, and glycemic control parameters were assessed. Insulin resistance was evaluated with the hyperinsulinemic euglycemic clamp test. All tests were repeated after six months of CSII treatment. The Wilcoxon matched-pairs signed-rank test and Spearman's rank correlation coefficient were used for statistical evaluation. Results are presented as median (1st quartile; 3rd quartile).
There were no changes in long-term glycemic control during the course of CSII treatment: HbA1c prior to CSII 9.60 (8.95; 10.60) vs. after 6 months 9.80 (9.50; 10.20) %, BMI 33.0 (32.1; 34.2) vs. 32.9 (32.0; 34.5), total daily insulin dose 69.0 (65.0; 94.0) vs. 68.0 (58.9; 92.4) IU/24 h in observed patients. There was a statistically significant improvement in insulin resistance: M value 2.55 (1.92; 3.15) vs. 3.32 (2.23; 4.49) mg/kg per min (P<0.01), and improvement in atherosclerosis risk factors (blood coagulation and endothelial dysfunction): fibrinogen 3.44 (3.13; 3.86) vs. 3.24 (2.77; 3.38) g/l, factor VII 115 (101; 128) vs. 109 (93; 119)%, factor VIII 230 (148; 260) vs. 188 (126; 225)%, vWF:RiCo 162 (141; 193) vs. 128 (100; 132)%, PAI-1 39 (30; 44) vs. 30 (25; 36) AU/ml, thrombomodulin Ag 4.1 (3.7; 4.4) vs. 3.7 (3.45; 4.05) ng/ml (P<0.01).
Six months of CSII treatment led to decrease in insulin resistance and improvement in parameters of lipid metabolism, blood coagulation and endothelial dysfunction independently of glycemic control and weight.
我们研究的目的是评估长期胰岛素泵治疗（持续皮下胰岛素输注，CSII）对胰岛素抵抗且2型糖尿病控制不佳患者代谢综合征参数的影响。
13名肥胖（体重指数>30）患者（8名女性，5名男性），平均年龄58.8±9.06岁，接受高剂量胰岛素（>0.8 IU/kg每24小时）强化胰岛素治疗至少12个月，被纳入研究。在CSII治疗前，所有患者均接受糖尿病治疗和代谢综合征再教育，并评估血糖控制参数。采用高胰岛素正常血糖钳夹试验评估胰岛素抵抗。在CSII治疗6个月后重复所有测试。采用Wilcoxon配对符号秩检验和Spearman等级相关系数进行统计学评估。结果以中位数（第1四分位数；第3四分位数）表示。
在CSII治疗过程中，长期血糖控制无变化：CSII治疗前糖化血红蛋白（HbA1c）为9.60（8.95；10.6）%，6个月后为9.80（9.50；10.20）%，体重指数（BMI）分别为33.0（32.1；34.2）和32.9（32.0；34.5），观察患者每日胰岛素总剂量分别为69.0（65.0；94.0）和68.0（58.9；92.4）IU/24小时。胰岛素抵抗有统计学显著改善：M值从2.55（1.92；3.15）mg/kg每分钟改善为3.32（2.23；4.49）mg/kg每分钟（P<0.01），动脉粥样硬化危险因素（血液凝固和内皮功能障碍）也有改善：纤维蛋白原从3.44（3.13；3.86）g/L改善为3.24（2.77；3.38）g/L，凝血因子VII从115（101；128）%改善为109（93；119）%，凝血因子VIII从230（148；260）%改善为188（126；225）%，血管性血友病因子：瑞斯托霉素辅因子（vWF:RiCo）从162（141；193）%改善为128（100；132）%，纤溶酶原激活物抑制剂-1（PAI-1）从39（30；44）AU/ml改善为30（25；36）AU/ml，血栓调节蛋白抗原从4.1（3.7；4.4）ng/ml改善为3.7（3.45；4.05）ng/ml（P<0.01）。
6个月的CSII治疗导致胰岛素抵抗降低，脂质代谢、血液凝固和内皮功能障碍参数改善，且与血糖控制和体重无关。
