【摘要】 目的 探讨不同MS诊断标准对新诊断T2DM患者合并MS患病率的影响，以及二甲双胍（Met）和阿卡波糖（Aca）的疗效。方法 选取MARCH研究的新诊断T2DM患者648例，按照5种不同MS诊断标准，比较MS患病率及Met和Aca基于不同诊断标准的疗效。结果 基于中华医学会糖尿病学分会（CDS）2004、CDS 2013、美国国家胆固醇教育计划成人治疗方案第3次修订版（NCEP-ATPⅢ）、国际糖尿病联盟（IDF）和IDF流行病预防工作组联合过渡声明（JIS）诊断标准，新诊断T2DM患者MS患病率分别为53.2%、65.1%、73.5%、60.3%、77.0%。基于NCEP-ATPⅢ和IDF标准MS患病率女性均高于男性（P<0.05）；除CDS 2013标准外，基于其余标准的不同年龄段MS患病率比较，差异有统计学意义（P<0.05），中老年组（≥40岁）MS患病率较高（P<0.05）。基于5种MS诊断标准，Aca治疗可降低不同诊断标准MS的患病率，基于IDF诊断标准，Met治疗后MS检出率低于治疗前（P<0.05）。基于5种MS诊断标准，Aca可显著降低T2DM不合并MS患者2 hPG,Met及Aca均可降低BG、血脂、IR,Met降低LDL-C及Aca降低TG、2 hPG效果更显著（P<0.05）。结论 NCEP-ATPⅢ和JIS标准对新诊断T2DM患者MS检出率较其他标准高，有助于筛查MS。基于5种MS诊断标准，Aca可有效降低新诊断T2DM患者MS患病率，基于CDS2013、NCEP-ATPⅢ、IDF和JIS诊断标准，Met及Aca治疗对MS患病率的影响近似。基于不同MS诊断标准，Met及Aca均有降糖、调脂、改善胰岛功能的作用。更多还原

【Abstract】 Objective To evaluate the prevalence of metabolic syndrome(MS) under different diagnostic criteria in newly onset type 2 diabetes mellitus(T2DM) and the clinical efficacy of Metformin and Acarbose. Methods A total of 648 patients with newly diagnosed T2DM were enrolled in the study from the database of the MARCH trial. The prevalence of MS were compared according to five diagnostic criteria,the therapeutic efficacy of Metformin and Acarbose were compared under the different diagnostic criteria. Results According to the Chinese Diabetes Society(CDS)2004,CDS 2013,National Cholesterol Education Program Adult Treatment Panel Ⅲ（NCEP-ATP Ⅲ）,Internation Diabetes Federation(IDF) and Joint Transition Statement by the IDF Epidemiology Prevention Working Group(JIS) diagnostic criteria,the prevalence of MS was 53. 2%,65. 1%,73. 5%,60. 3%,and 77. 0%,respectively in patients with newly diagnosed T2DM. The prevalence of MS was higher in women than in man population according to the criteria of NCEP-ATP Ⅲ and IDF(P<0. 05),and there were significant differences in the prevalence of MS among different age groups except for the criteria of CDS 2013(P<0. 05),the incidence rate was higher in middle-aged and elderly group（≥40 years old）. Under the five diagnostic criteria,Acarbose treatment reduced the prevalence of MS. Based on IDF diagnostic criteria,the detection rate of MS after Metformin treatment was lower than that before treatment(P<0. 05). Acarbose significantly reduced two-hour postprandial plasma glucose(2 h PG)in T2DM without MS patients. Both Metformin and Acarbose reduced blood glucose,lipids,and insulin resistance under different criteria. Metformin was superior in lowering low density lipoprotein cholesterol,and Acarbose was superior in reducing triglyceride and 2 hPG,and the difference was statistically significant(P<0. 05). Conclusions In newly diagnosed T2DM patients,the detection rate of MS was higher under NCEP-ATP Ⅲ criteria and JIS criteria than other criteria,which helped in MS screening.Under the five diagnostic criteria,acarbose was effective in reducing the prevalence of MS in newly diagnosed T2DM patients. The effects of Metformin and Acarbose treatment on the prevalence of MS were similar under CDS 2013,NCEP-ATP Ⅲ,IDF and JIS diagnostic criteria. Under different criteria,both Metformin and Acarbose have hypoglycemic,lipid-regulating,and islet function-improving effects.更多还原