摘要
目的 基于IRS-1/PI3K/GLUT4 胰岛素代谢通路探究微量泵持续胰岛素泵入联合奥曲肽治疗糖尿病酮症酸中毒(DKA)的作用机制.方法 选取2019 年10 月—2021 年10 月收治的60 例DKA为研究对象,依据给药方式不同分为对照组和观察组,每组30 例.对照组予以静脉缓慢滴注胰岛素联合奥曲肽治疗,观察组予以微量泵持续胰岛素泵入联合奥曲肽治疗.比较2 组临床疗效、症状改善时间、住院时间、维持胰岛素用量、血糖控制水平、血气分析、氧化应激反应、IRS-1/PI3K/GLUT4 胰岛素代谢通路相关分子表达及低血糖发生率.结果 观察组临床总有效率为93.33%(28/30)高于对照组的70.00%(21/30)(P＜0.05).观察组尿酮体转阴时间、血糖达标时间及住院时间短于对照组,维持胰岛素用量少于对照组(P＜0.05).治疗3、7d后,观察组空腹血糖、餐后2h血糖、糖化血红蛋白、丙二醛水平低于对照组,pH值、碳酸氢根离子、二氧化碳结合力、超氧化物歧化酶、总抗氧化能力、谷胱甘肽过氧化物酶及IRS-1、PI3K、GLUT4 表达水平高于对照组(P＜0.05).观察组治疗期间低血糖发生率为6.67%(2/30)低于对照组的30.00%(9/30)(P＜0.05).结论 微量泵持续胰岛素泵入联合奥曲肽对DKA疗效确切,能改善患者血气分析指标及血糖水平,有效避免低血糖发生,可能与调节IRS-1/PI3K/GLUT4 胰岛素代谢通路、减轻氧化应激反应有关.
Abstract
Objective To investigate the mechanism of action of continuous pumping of insulin with micropump com-bined with Octreotide in the treatment of diabetic ketoacidosis(DKA)based on the IRS-1/PI3K/GLUT4 insulin metabolic pathway.Methods Sixty patients with DKA treated from October 2019 to October 2021 were selected as the research sub-jects and divided into control group(n =30)and observation group(n =30)according to different administration methods.The control group was treated with slow intravenous insulin infusion combined with Octreotide,and the observation group was treated with continuous pumping of insulin with micropump combined with Octreotide.The clinical efficacy,symptom improve-ment time,length of hospital stay,maintenance dosage of insulin,blood glucose control level,blood gas analysis,oxidative stress response,expression of IRS-1/PI3K/GLUT4 insulin metabolic pathway and incidence of hypoglycemia were compared between the two groups.Results The total effective rate of the observation group was 93.33%(28/30),which was higher than that of the control group[70.00%(21/30)](P＜0.05).The time of positive-to-negative conversion of urine ketone body,the time of blood glucose reaching the standard and the length of hospitalization in the observation group were shorter than those in the control group,and the maintenance dosage of insulin was lower than that in the control group(P＜0.05).At 3 and 7 days after treatment,fasting blood glucose,2 h postprandial blood glucose,glycated hemoglobin and malondialde-hyde levels in the observation group were lower than those in the control group,while the levels of pH,bicarbonate ion,car-bon dioxide binding capacity,superoxide dismutase,total antioxidant capacity,glutathione peroxidase and IRS-1,PI3K and GLUT4 were higher than those of control group(P＜0.05).The incidence of hypoglycemia in the observation group was 6.67%(2/30),which was lower than that in the control group[30.00%(9/30)](P＜0.05).Conclusion Continuous pumping of insulin with micropump combined with Octreotide has a definite effect on DKA,which can improve blood gas anal-ysis indexes and blood glucose levels in patients and effectively avoid hypoglycemia.This may be related to regulating IRS-1/PI3K/GLUT4 insulin metabolic pathway and alleviating oxidative stress.
基金项目
河北省医学科学研究课题计划项目(20211713)
张家口市重点研发计划项目(2021130H)
国家科技期刊平台
NSTL
万方数据