BMJ：胰岛素泵或降低1型糖尿病患者心血管风险

2015-07-03 sunshine 译 MedSci原创

胰岛素泵——1型糖尿病患者的新选择虽然与2型糖尿病(T2DM)患者相比1型糖尿病(T1DM)患者的数量较小，但是1型糖尿病患者发生心血管疾病的风险却很大。与T2DM相比，对T1DM行强化血糖控制（使用胰岛素）可明显减少大血管和微血管的并发症，这种强化血糖控制通常采用每日多次注射（MDI)的方法。胰岛素泵，通常配备了血糖监测功能，可提供更简便且连续的胰岛素给药途径，年轻患者中使用的较多。尽管理论上胰

虽然与2型糖尿病(T2DM)患者相比1型糖尿病(T1DM)患者的数量较小，但是1型糖尿病患者发生心血管疾病的风险却很大。与T2DM相比，对T1DM行强化血糖控制（使用胰岛素）减少大血管和微血管的并发症已经得到了明确的证明，这种强化血糖控制通常采用每日多次注射（MDI)的方法。胰岛素泵，通常配备了血糖监测功能，可提供更简便且连续的胰岛素给药途径，年轻患者中使用的较多。尽管理论上胰岛素的使用好处较多，但是前瞻性研究检测显示，与MDI相比胰岛素泵对心血管疾病的效果并无差别。

图 1.经过胰岛素泵治疗或MDI治疗的18168名1型糖尿病患者

Kaplan-Meier生存曲线（点击图可放大）

Steineck及其同事在该观察性研究中发现，近7年的随访结束后，在瑞典国家糖尿病登记中心的T1DM患者胰岛素泵的使用与较少的致命性及非致命性心血管疾病并发症有关。有趣的是，胰岛素泵与MDI （平均HbA1c -8%）相比，并未观察到HbA1c的水平有明显差异，但是使用胰岛素泵的患者却很少会发生低血糖。然而，尽管该研究大量的数据已校正混杂因素，但是我们仍不能从这些数据中分辨出二者之间是确实存在因果关系（例如，胰岛素泵使用效果更好），还是仅仅是因为健康患者使用胰岛素泵与患者使用MDI相比。目前有几种理论可以解释胰岛素泵改善血糖的原理，包括减少低血糖的发生，同时降低餐后高血糖的发生。

图2 7年随访中1型糖尿病患者发生

低血糖事件的Kaplan-Meier生存曲线（点击图可放大）

与MDI相比，胰岛素泵提供了更为灵活且简便的胰岛素给药措施，且可能更好的保护心血管，但是仍需进一步的前瞻性研究以证实这一假设的正确性。

拓展知识：

胰岛素泵：

胰岛素泵由泵、小注射器和与之相连的输液管组成。小注射器最多可以容纳3毫升的胰岛素，注射器装入泵中后，将相连的输液管前端的引导针用注针器扎入患者的皮下（常规为腹壁），再由电池驱动胰岛素泵的螺旋马达推动小注射器的活塞，将胰岛素输注到体内胰岛素泵的基本用途是模拟胰腺的分泌功能，按照人体需要的剂量将胰岛素持续地推注到使用者的皮下，保持全天血糖稳定，以达到控制糖尿病的目的。

胰岛素泵工作原理（点击可放大）

原始出处：

Insulin Delivery Method and Cardiovascular Mortality in Type 1 Diabetes.

Steineck I1, Cederholm J2, Eliasson B3, Rawshani A4, Eeg-Olofsson K3, Svensson AM4, Zethelius B5, Avdic T4, Landin-Olsson M6, Jendle J7, Gudbjörnsdóttir S8; Swedish National Diabetes Register.Insulin pump therapy, multiple daily injections, and cardiovascular mortality in 18 168 people with type 1 diabetes: observational study.BMJ. 2015 Jun 22;350:h3234. doi: 10.1136/bmj.h3234.[pdf free]

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2016-01-21 baoya

#胰岛#

36 0
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2015-09-14 millore

#1型糖尿病患者#

36 0
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encodeId=095d14e3873bc, content=<a href='/topic/show?id=935fe6718e3' target=_blank style='color:#2F92EE;'>#糖尿病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76718, encryptionId=935fe6718e3, topicName=糖尿病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a38f7243741, createdName=xue8604, createdTime=Sat Jul 04 16:07:00 CST 2015, time=2015-07-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1545293, encodeId=456e15452931a, content=<a href='/topic/show?id=d49b8390451' target=_blank style='color:#2F92EE;'>#胰岛素泵#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83904, encryptionId=d49b8390451, topicName=胰岛素泵)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=739113711075, createdName=12498a1cm71暂无昵称, createdTime=Sat Jul 04 16:07:00 CST 2015, time=2015-07-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=30509, encodeId=c21f305098f, content=看看, beContent=null, objectType=article, channel=null, level=null, likeNumber=110, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ee0d1618732, createdName=huaxipanxing, createdTime=Sat Jul 04 14:58:00 CST 2015, time=2015-07-04, status=1, ipAttribution=)]
2016-05-25 ms5353107019656438

#血管风险#

34 0
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replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKT7Exm9wh9wsVDUxNuicyfcsIlwSMQjeu0bnzjBBXuXgCq0GxthROPNEmfhfLpCZC3qDjpSK7LeyA/132, createdBy=67811617930, createdName=dreamslink, createdTime=Tue Jul 28 21:29:00 CST 2015, time=2015-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=33194, encodeId=4fca33194d3, content=不错哦，收藏了！, beContent=null, objectType=article, channel=null, level=null, likeNumber=139, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzTetibytbqFDmFITWHyBWbxU7S9MYibgPSqvu0sYteH0N6zXqbU0Kf3Mbdb7yWM1Kud3zPgYBibE2SZ/0, createdBy=da7696924, createdName=qingfengqishi5, createdTime=Tue Jul 21 00:35:00 CST 2015, time=2015-07-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1473873, encodeId=095d14e3873bc, content=<a href='/topic/show?id=935fe6718e3' target=_blank style='color:#2F92EE;'>#糖尿病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76718, encryptionId=935fe6718e3, topicName=糖尿病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a38f7243741, createdName=xue8604, createdTime=Sat Jul 04 16:07:00 CST 2015, time=2015-07-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1545293, encodeId=456e15452931a, content=<a href='/topic/show?id=d49b8390451' target=_blank style='color:#2F92EE;'>#胰岛素泵#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83904, encryptionId=d49b8390451, topicName=胰岛素泵)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=739113711075, createdName=12498a1cm71暂无昵称, createdTime=Sat 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2015-09-01 gaoxiaoe

#BMJ#

34 0
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replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKT7Exm9wh9wsVDUxNuicyfcsIlwSMQjeu0bnzjBBXuXgCq0GxthROPNEmfhfLpCZC3qDjpSK7LeyA/132, createdBy=67811617930, createdName=dreamslink, createdTime=Tue Jul 28 21:29:00 CST 2015, time=2015-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=33194, encodeId=4fca33194d3, content=不错哦，收藏了！, beContent=null, objectType=article, channel=null, level=null, likeNumber=139, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzTetibytbqFDmFITWHyBWbxU7S9MYibgPSqvu0sYteH0N6zXqbU0Kf3Mbdb7yWM1Kud3zPgYBibE2SZ/0, createdBy=da7696924, createdName=qingfengqishi5, createdTime=Tue Jul 21 00:35:00 CST 2015, time=2015-07-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1473873, encodeId=095d14e3873bc, content=<a href='/topic/show?id=935fe6718e3' target=_blank style='color:#2F92EE;'>#糖尿病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76718, encryptionId=935fe6718e3, topicName=糖尿病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a38f7243741, createdName=xue8604, createdTime=Sat Jul 04 16:07:00 CST 2015, time=2015-07-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1545293, encodeId=456e15452931a, content=<a href='/topic/show?id=d49b8390451' target=_blank style='color:#2F92EE;'>#胰岛素泵#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83904, encryptionId=d49b8390451, topicName=胰岛素泵)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=739113711075, createdName=12498a1cm71暂无昵称, createdTime=Sat Jul 04 16:07:00 CST 2015, time=2015-07-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=30509, encodeId=c21f305098f, content=看看, beContent=null, objectType=article, channel=null, level=null, likeNumber=110, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ee0d1618732, createdName=huaxipanxing, createdTime=Sat Jul 04 14:58:00 CST 2015, time=2015-07-04, status=1, ipAttribution=)]
2015-07-28 dreamslink

赞

79 0
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replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Tue Sep 01 21:07:00 CST 2015, time=2015-09-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=33681, encodeId=02183368108, content=赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKT7Exm9wh9wsVDUxNuicyfcsIlwSMQjeu0bnzjBBXuXgCq0GxthROPNEmfhfLpCZC3qDjpSK7LeyA/132, createdBy=67811617930, createdName=dreamslink, createdTime=Tue Jul 28 21:29:00 CST 2015, time=2015-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=33682, encodeId=18a2336828a, content=赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=115, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKT7Exm9wh9wsVDUxNuicyfcsIlwSMQjeu0bnzjBBXuXgCq0GxthROPNEmfhfLpCZC3qDjpSK7LeyA/132, createdBy=67811617930, createdName=dreamslink, createdTime=Tue Jul 28 21:29:00 CST 2015, time=2015-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=33194, encodeId=4fca33194d3, content=不错哦，收藏了！, beContent=null, objectType=article, channel=null, level=null, likeNumber=139, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzTetibytbqFDmFITWHyBWbxU7S9MYibgPSqvu0sYteH0N6zXqbU0Kf3Mbdb7yWM1Kud3zPgYBibE2SZ/0, createdBy=da7696924, createdName=qingfengqishi5, createdTime=Tue Jul 21 00:35:00 CST 2015, time=2015-07-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1473873, encodeId=095d14e3873bc, content=<a href='/topic/show?id=935fe6718e3' target=_blank style='color:#2F92EE;'>#糖尿病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76718, encryptionId=935fe6718e3, topicName=糖尿病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a38f7243741, createdName=xue8604, createdTime=Sat Jul 04 16:07:00 CST 2015, time=2015-07-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1545293, encodeId=456e15452931a, content=<a href='/topic/show?id=d49b8390451' target=_blank style='color:#2F92EE;'>#胰岛素泵#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83904, encryptionId=d49b8390451, topicName=胰岛素泵)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=739113711075, createdName=12498a1cm71暂无昵称, createdTime=Sat Jul 04 16:07:00 CST 2015, time=2015-07-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=30509, encodeId=c21f305098f, content=看看, beContent=null, objectType=article, channel=null, level=null, likeNumber=110, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ee0d1618732, createdName=huaxipanxing, createdTime=Sat Jul 04 14:58:00 CST 2015, time=2015-07-04, status=1, ipAttribution=)]
2015-07-28 dreamslink

赞

115 0
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replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKT7Exm9wh9wsVDUxNuicyfcsIlwSMQjeu0bnzjBBXuXgCq0GxthROPNEmfhfLpCZC3qDjpSK7LeyA/132, createdBy=67811617930, createdName=dreamslink, createdTime=Tue Jul 28 21:29:00 CST 2015, time=2015-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=33194, encodeId=4fca33194d3, content=不错哦，收藏了！, beContent=null, objectType=article, channel=null, level=null, likeNumber=139, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzTetibytbqFDmFITWHyBWbxU7S9MYibgPSqvu0sYteH0N6zXqbU0Kf3Mbdb7yWM1Kud3zPgYBibE2SZ/0, createdBy=da7696924, createdName=qingfengqishi5, createdTime=Tue Jul 21 00:35:00 CST 2015, time=2015-07-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1473873, encodeId=095d14e3873bc, content=<a href='/topic/show?id=935fe6718e3' target=_blank style='color:#2F92EE;'>#糖尿病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76718, encryptionId=935fe6718e3, topicName=糖尿病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a38f7243741, createdName=xue8604, createdTime=Sat Jul 04 16:07:00 CST 2015, time=2015-07-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1545293, encodeId=456e15452931a, content=<a href='/topic/show?id=d49b8390451' target=_blank style='color:#2F92EE;'>#胰岛素泵#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83904, encryptionId=d49b8390451, topicName=胰岛素泵)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=739113711075, createdName=12498a1cm71暂无昵称, createdTime=Sat 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2015-07-21 qingfengqishi5

不错哦，收藏了！

139 0
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2015-07-04 xue8604

#糖尿病患者#

21 0
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2015-07-04 12498a1cm71暂无昵称

#胰岛素泵#

43 0
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replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Tue Sep 01 21:07:00 CST 2015, time=2015-09-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=33681, encodeId=02183368108, content=赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKT7Exm9wh9wsVDUxNuicyfcsIlwSMQjeu0bnzjBBXuXgCq0GxthROPNEmfhfLpCZC3qDjpSK7LeyA/132, createdBy=67811617930, createdName=dreamslink, createdTime=Tue Jul 28 21:29:00 CST 2015, time=2015-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=33682, encodeId=18a2336828a, content=赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=115, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKT7Exm9wh9wsVDUxNuicyfcsIlwSMQjeu0bnzjBBXuXgCq0GxthROPNEmfhfLpCZC3qDjpSK7LeyA/132, createdBy=67811617930, createdName=dreamslink, createdTime=Tue Jul 28 21:29:00 CST 2015, time=2015-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=33194, encodeId=4fca33194d3, content=不错哦，收藏了！, beContent=null, objectType=article, channel=null, level=null, likeNumber=139, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzTetibytbqFDmFITWHyBWbxU7S9MYibgPSqvu0sYteH0N6zXqbU0Kf3Mbdb7yWM1Kud3zPgYBibE2SZ/0, createdBy=da7696924, createdName=qingfengqishi5, createdTime=Tue Jul 21 00:35:00 CST 2015, time=2015-07-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1473873, encodeId=095d14e3873bc, content=<a href='/topic/show?id=935fe6718e3' target=_blank style='color:#2F92EE;'>#糖尿病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76718, encryptionId=935fe6718e3, topicName=糖尿病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a38f7243741, createdName=xue8604, createdTime=Sat Jul 04 16:07:00 CST 2015, time=2015-07-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1545293, encodeId=456e15452931a, content=<a href='/topic/show?id=d49b8390451' target=_blank style='color:#2F92EE;'>#胰岛素泵#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83904, encryptionId=d49b8390451, topicName=胰岛素泵)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=739113711075, createdName=12498a1cm71暂无昵称, createdTime=Sat Jul 04 16:07:00 CST 2015, time=2015-07-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=30509, encodeId=c21f305098f, content=看看, beContent=null, objectType=article, channel=null, level=null, likeNumber=110, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ee0d1618732, createdName=huaxipanxing, createdTime=Sat Jul 04 14:58:00 CST 2015, time=2015-07-04, status=1, ipAttribution=)]
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BMJ：胰岛素泵或降低1型糖尿病患者心血管风险

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