12 周不同剂量盐酸吡格列酮治疗对2型糖尿病患者总体水含量的影响

目的探讨盐酸吡格列酮治疗前后体内总体水含量与药物时效、量效的关系。方法随机人选我院门诊口服降糖药血糖控制不良的2型糖尿病患者。在原降糖治疗的基础上加用盐酸吡格列酮口服，起始剂量为15mg／d，每4周随访并根据血糖调整剂量，共随访12周。分别检测治疗前后的空腹／餐后2小时血糖、空腹血脂、糖化血红蛋白、红细胞压积、体质量，根据Watson公式计算总体水含量。结果签署知情同意书并符合入组条件的2型糖尿病患者男28例、女29例，年龄25～69岁。实际完成51例，治疗后空腹血糖较治疗前明显下降。方差分析发现服药4周、8周和12周的总体水含量与基线的差值均数（ATBW）之间存在组间差异，△TBW12均数随盐酸吡格列酮剂量分组值的增加而增加，并呈线性趋势（P=0．013）。两两比较提示ATBW12分别较△TBW4、△TBW8增多。男性总体水含量高于女性、女性2型糖尿病受试者ATBW4、ATBW8和ATBW12值呈线性趋势．30mg组和45mg组的△TBW12明显高于△TBW4，男性2型糖尿病受试者各组△TBW差异无统计学意义。结论盐酸吡格列酮可以明显改善2型糖尿病患者的糖代谢紊乱，但随着治疗时间延长或剂量增大，机体总体水含量增多，尤以女性明显。评价是否存在噻唑烷二酮类药物相关的水潴留，采用Watson公式估算总体水含量可能是临床可行的筛查方法之一。

The Effect on the Total Body Water of Type 2 Diabetes Patients Treated with Different Doses of Pioglitazone Hydrochloride in 12 Weeks

Objective TZDs is the medicine to decrease the blood glucose, but it has the side-effect of edema and water retention in body. In our research, we estimated the total body water （TBW） of patients with type 2 diabetes after different doses of treatment of Pioglitazone hydrochloride in 12 weeks. Methods In an open, controlled trial, 57 patients with type 2 diabetes who were under poor blood glucose control were enrolled. Additional Pioglitazone hydrochloride would be used combining with drugs used before, with a dose of 15 mg/d. After 4 weeks, Pioglitazone hydrochloride dose would increase to 30 mg/d if the fasting blood glucose could not match the goal （7.0 mmol/L）. Another 4 weeks, if the fasting blood glucose could not match the goal, Pioglitazone hydrochloride dose would increase to 45 mg/d. Fasting and 2 hours postprandial blood glucose, fasting blood lipid, glycosylated hemoglobin, hematocrit, body mass, electrocardiogram would be tested before and after treatment. Calculated BMI and estimated TBW by the Watson formula. Results Those subjects with type 2 diabetes who signed informed consent form were eligible for the cases（28 male and 29 female, aged from 25 to 69）. Among these 57 cases, 51 of them were efficient. By AVON analysis, we found that ATBW and Aweight had significant differences among the 4 week, 8 week and 12 week groups, and showed the linear correlation. Compared to △TBW4 and ATBWS, △TBW12 significantly increased. TBW of males was higher than females. In female subjects, △TBW4, △TBW8 and △TBW12 showed the linear correlation, and △TBW12 of 30 mg/d groups and 45 mg/d groups were higher than △TBW4, but showed on difference in the male subjects. Conclusion With increasing dose of Pioglitazone hydrochloride and prolonging the treatment, TBW of patients with type 2 diabetes increased, especially for the female subjects.