肝移植后糖代谢紊乱的治疗方法和效果

目的 探讨在饮食控制的基础上,甘精胰岛素联合瑞格列奈治疗肝移植后糖尿病的疗效和安全性.方法 收集2010年1月1日至12月31日在我院确诊为肝移植后糖尿病的受者,在饮食控制的基础上,应用甘精胰岛素联合瑞格列奈治疗6个月,观察治疗前和治疗后1、3、6个月时空腹血糖、餐后2h血糖、糖化血红蛋白、肝肾功能和他克莫司浓度.结果 共纳入病例44例,在饮食控制的基础上,3例未用任何降糖药,7例仅加用瑞格列奈,30例使用甘精胰岛素联合瑞格列奈治疗,4例最终应用胰岛素强化治疗方案,均达到满意疗效.治疗后1、3、6个月时的空腹血糖、餐后2h血糖达标;治疗6个月时糖化血红蛋白水平达标;治疗前后肝肾功能各项指标和血清他克莫司水平差异无统计学意义(P＞0.05);治疗过程中发生5次低血糖反应,最低血糖为3.7 mmol/L,无严重低血糖发生.结论 在饮食控制的基础上,甘精胰岛素联合瑞格列奈可作为肝移植后糖尿病受者一种安全有效的降糖药物.

Treatment methods and effect of glucose metabolit disorders after liver transplantation

ObjectiveTo evaluate the efficacy and safety of glargine combined with repaglinide in the treatment of post-transplantation diabetes mellitus （PTDM）. MethodsPTDM patients who were treated in our hospital from Jan 1,2010 to Dec 31,2010 were enrolled in this study. They were administrated with glargine combined with repaglinide for 6 months, and their glucose level, hepatic and renal function indicators, and tacrolimus concentration were examined at baseline and 1, 3, and 6 months after treatment. ResultsTotally 44 patients were included and given dietary control. Three cases were not given any hypoglycemic drugs,7 were administrated with glargine only, 30 cases received glargine combined with repaglinide therapy, and 4 cases required intensive insulin therapy. All the patients achieved satisfactory glycemic control. The hepatic function, renal function, and serum tacrolimus concentration showed no significant change before and after repaglinide therapy （P〉0.05）. Five hypoglycemic events were recorded during the treatment, in which the lowest blood glucose level was 3.7 mmol/L. No severe hypoglycemia happened. ConclusionOn the basis of dietary control,glargine combined with repagli- nide provides a safe and effective therapy for PTDM.