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目的观察应用双C和MSII治疗2型糖尿病(type 2 diabetes mellitus,T2DM)合并社区获得性肺炎(community acquired pneumonia,CAP)患者强化血糖控制的有效性和安全性。方法将2004年10月至2009年10月在我院住院的未使用过胰岛素治疗的T2DM合并CAP患者99例随机分为双C组(50例)和MSII组(49例),分别给予双C和MSII。双C是应用持续皮下胰岛素输注(CSII)结合动态血糖监测系统(CGMS)-即“双C”方案。MSII是每日多次皮下注射胰岛素(MSII)结合每日八次指尖血糖监测。两组患者应用胰岛素和抗生素治疗后,观察CAP主要症状缓解时间、血糖达标时间、胰岛素用量、低血糖发生频率及肺炎控制时间的差异。结果双C组和MSII组患者治疗后空腹血糖分别为(6.3±0.2)mmol/L和(6.8±1.2)mmol/L,餐后2h血糖分别为(8.7±0.4)mmol/L和(9.3±1.2)mmol/L,均能达标。治疗后双C组患者果糖胺(7.2±0.13)mmol/L与MSII组(9.0±0.11)mmol/L比较,差异有统计学意义(P<0.01)。双C组患者肺炎主要症状(发热、胸痛、咳黄痰、剧烈咳嗽、呼吸困难和湿啰音)缓解时间分别为(4.2±1.8)d、(3.7±1.2)d、(4.7±1.8)d、(8.2±1.3)d、(8.3±1.1)d和(9.2±2.6)d,血糖达标时间为(3.7±0.6)d、肺炎控制时间(12.8±4.5)d、胰岛素用量(37.6±6.5)U/d及低血糖发生频率(0.6±0.4)次/例;MSII组分别为(6.2±1.7)d、(4.3±1.4)d、(8.4±2.5)d、(9.6±3.5)d、(9.6±3.4)d、(12.4±4.1)d、(7.2±1.2)d、(18.2±6.8)d、(57.2±10.3)U/d和(4.3±0.7)次/例,两组比较差异均有统计学意义(P<0.05)。结论在配合抗生素的前提下,“双C”方案治疗能及时、有效地控制T2DM合并CAP患者的血糖水平,肺炎症状缓解时间及治愈肺炎的时间均较MSII组短,而且胰岛素用量少,低血糖发生率低,是理想的治疗方法。
Objective To investigate the efficacy and safety of double C and MSII in the treatment of type 2 diabetes mellitus (T2DM) and community acquired pneumonia (CAP) patients with intensive glycemic control. Methods Ninety-nine patients with untreated insulin-refractory T2DM and CAP hospitalized in our hospital from October 2004 to October 2009 were randomly divided into double C group (n = 50) and MSII group (n = 49) And MSII. Double C is a combination of continuous subcutaneous insulin infusion (CSII) with an ambulatory blood glucose monitoring system (CGMS) - the “double C” protocol. MSII is administered daily subcutaneously (MSII) in combination with fingertip blood glucose monitoring eight times daily. Two groups of patients treated with insulin and antibiotics, observed the main symptoms of CAP time to relief, blood glucose compliance time, insulin dosage, frequency of hypoglycemia and pneumonia control time differences. Results The fasting blood glucose (FBG) was (6.3 ± 0.2) mmol / L and (6.8 ± 1.2) mmol / L after treatment in patients with dual C and MSII respectively and (8.7 ± 0.4) mmol / L and 1.2) mmol / L, can meet the standard. After treatment, the fructosamine (7.2 ± 0.13) mmol / L in double C group was significantly higher than that in MSII group (9.0 ± 0.11) mmol / L (P <0.01). The response time of the main symptoms of pneumonia (fever, chest pain, cough yellow sputum, severe cough, dyspnea and wet rales) in patients in double C group were (4.2 ± 1.8) days, (3.7 ± 1.2 days), (4.7 ± 1.8 days) (8.2 ± 1.3) d, (8.3 ± 1.1) d and (9.2 ± 2.6) d respectively, the time of reaching the standard of glycemic control was (3.7 ± 0.6) d, the duration of pneumonia control was 12.8 ± 4.5 days, the dosage of insulin was (37.6 ± 6.5) (6.2 +/- 0.4) d, (8.4 +/- 2.5) d, (9.6 +/- 3.5) d, ( 9.6 ± 3.4) d, (12.4 ± 4.1) d, (7.2 ± 1.2) d, (18.2 ± 6.8) d, (57.2 ± 10.3) U / d and (4.3 ± 0.7) There was statistical significance (P <0.05). Conclusions With the premise of antibiotics, the treatment with “double C” regimen can control the blood sugar level, the time of pneumonia symptom relief and the cure of pneumonia in T2DM patients with CAP in a timely and effective way, and the dosage of insulin is less than that of MSII group , Low incidence of hypoglycemia, is the ideal treatment.