地特胰岛素与甘精胰岛素对2型糖尿病合并痛风患者血尿酸、胰岛素抵抗、IL-1β、TLR-4水平的影响

Effects of insulin detemir and insulin glargine on serum uric acid, insulin resistance and IL-1β/TLR-4 expression in the treatment of type 2 diabetes mellitus with gout

摘要:

目的比较地特胰岛素与甘精胰岛素治疗2型糖尿病合并痛风患者,对血尿酸、胰岛素抵抗、血清白细胞介素-1β(IL-1β)、Toll样受体-4(TLR-4)水平的影响。 方法选择2型糖尿病合并痛风急性发作患者共124例,随机均分为对照组和观察组。对照组采用甘精胰岛素,观察组采用地特胰岛素,连续治疗12周。比较两组治疗前后空腹血糖(FBG)、空腹胰岛素(FINS)、餐后2 h血糖(2hBG)、餐后2 h胰岛素(2hINS)和糖化血红蛋白(HbA1c),计算胰岛素抵抗指数(HOMA-IR),比较两组低血糖事件、体质量增加量、胰岛素用量,比较两组治疗前后血尿酸、IL-1β和TLR-4水平。 结果两组治疗后FBG、FINS、2hBG、2hINS、HbA1c和HOMA-IR水平较治疗前明显改善(P＜0.05),但两组患者上述指标的改善程度差异无统计学意义(P＞0.05)。观察组低血糖发生率、体质量增加量较对照组减少(P＜0.05)。两组治疗后血尿酸、IL-1β和TLR-4水平较治疗前降低,且观察组低于对照组(P＜0.05)。 结论地特胰岛素与甘精胰岛素治疗2型糖尿病合并痛风患者对血糖控制和胰岛素抵抗的影响基本相当,但前者低血糖事件及体质量增加量少,降低血尿酸、IL-1β、TLR-4水平,在痛风控制方面获益更大。

Abstract:

To compare the influences of insulin detemir and insulin glargine on serum uric acid, insulin resistance, interleukin-1β(IL-1β) and Toll-like receptor(TLR-4) expression in treatment of patients with type 2 diabetes mellitus and gout, then analyze the mechanism of different insulins on gout. Methods124 patients with type 2 diabetes mellitus complicated with acute gout attack into were prospectively selected and divided into control and observation groups, 62 patients were in each group. The control group was given insulin glargine and the observation group was given insulin detemir for 12 weeks. Fasting blood glucose (FBG), fasting insulin(FINS), postprandial 2 h blood glucose (2hBG), postprandial 2 h insulin (2hINS) and glycosylated hemoglobin(HbA1c)before and after treatment were compared between the two groups before and after treatment, and then insulin resistance index(HOMA-IR) was calculated.The hypoglycemic event, body weight and insulin dosage, the serum uric acid, IL-1β and TLR-4 levels were compared between the two groups before and after treatment too. ResultsAfter treatment, the levels of FBG, FINS, 2hBG, 2hINS, HbAc and HOMA-IR in the two groups were all significantly improved compared with those before treatment (P＜0.05), but there was no significant difference in the improvement of the above indicators between the two groups (P＞0.05). The hypoglycemic incidence and body weight increasement in observation group were significantly lower than that in control group(P＜0.05). After treatment, the levels of sUA, IL-1β and TLR-4 in the two groups were lower than those before treatment, and they in observation group were significantly lower than the control group(P＜0.05). ConclusionThe effects are equal on blood glucose control and insulin resistance in patients with type 2 diabetes mellitus and gout by the former has less hypoglycemia events and body weight gain, serum uric acid and IL-1 β/TLR-4 activation, which could take more benefit of gout control.