双胍类降糖药治疗糖尿病血乳酸水平的观察

对40例无心、肝、肾并发症的非胰岛素依赖型糖尿病患者,进行了双胍类降糖药治疗的血乳酸变化和降糖疗效的观察。发现适当剂量的降糖灵和降糖片对这些病人降糖疗效较好,血乳酸水平变化不大,而较大剂量的降糖灵可导致高乳酸血症,应慎重使用。

ALTERATION OF BLOOD LACTIC ACID LEVEL ON BIGUANIDES THERAPY IN DIABETICS

The effects on blood 1actic acid and glucosecontrol during phenformin and metformintherapy were evaluated in 40 diabetics(NIDDM) who had no cardiac, hepatic orrenal complications. In phenformin treatedgroup(25 cases)fasting and postprandial plas-ma glucose levels were significantly lowered(P<0. 001)while blood lactic acid levels wereslightly increased (within normal range) aftera month's treatment with a dosage of 75 mg/day. Bot a mild hyperlactacidemia was obser-ved when phenformin dosage was increasedto 150 mg/day although further improvementof plasma glucose control was obtained.Most of the patients did not tolerate thegastro-intestinal side effects of large dosephenformin therapy. On the other hand, inmetformin treated group (15 cases) no signi-ficant increase of blood lactic acid levelsand gastro-intestinal side effects were obser-ved during the therapy with both dosages,750 mg/day for a month, and then 1500mg/day for another month, but the hypoglyce-mic effect of metformin was relatively wea-ker than that of phenformin. These resultssuggest that biguanides therapy with reaso-nable dosage in diabetics without cardiac,hepatic or renal complications may not leadto harmful hyperlactacidemia while a satis-fying hypoglycemic response is obtained,and hence may be used as a safe and effec-tive measure of treatment for these patients.But a large dosage of phenformin should beused with great care because of its trend ofincreasing blood lactic acid concentration.