目的 初步探讨二甲双胍、阿卡波糖对2型糖尿病合并甲状腺功能亢进症患者的降糖疗效及对肠道菌群的影响,为临床对于2型糖尿病合并甲状腺功能亢进症患者降糖药物的选择提供参考依据。方法 将入选的52例2型糖尿病合并甲状腺功能亢进症患者随机分为两组,二甲双胍组26例、阿卡波糖组26例,分别使用药物治疗,疗程为12周,在第4周,第8周,第12周检测各组的空腹血糖及餐后2小时血糖,并进行统计分析比较；在治疗前及治疗后12周分别留取新鲜大便标本,检测肠道菌群后进行比较。结果 阿卡波糖组患者餐后2小时血糖的调节优于二甲双胍组,且在后期(12周)降低空腹血糖效果亦更具优势；两组治疗后与治疗前相比各菌种变化差异具有统计学意义(P<0.05),而阿卡波糖组相比于二甲双胍组,双歧杆菌、乳杆菌等优势菌检出值更高,肠杆菌、肠球菌等致病菌检出值更低,组间差异均有统计学意义(P<0.05)。结论 对于2型糖尿病合并甲状腺功能亢进症患者,阿卡波糖治疗疗效优于二甲双胍。

Objective To preliminary explore the effect of metformin and acarbose on the hypoglycemic effect and intestinal flora in patients with type 2 diabetes mellitus complicated with hyperthyroidism, so as to provides a reference for the clinical selection of hypoglycemic drugs in patients with type 2 diabetes and hyperthyroidism. Methods The 52 selected patients with type 2 diabetes and hyperthyroidism were randomly divided into two groups:the metformin group with 26 cases (treated with metformin) and acarbose group with 26 cases (treated with acarbose), using drug therapy for 12 weeks accordingly, measuring fasting blood-glucose and postprandial 2 hours blood-glucose at 4 weeks, 8 weeks, 12 weeks, analyzing and comparing the data；Before treatment and 12 weeks after treatment, we collected Fresh stool samples to test intestinal flora,then compare the data. Results Patients in the acarbose group were better than the metformin group in regulating blood glucose 2 hours after a meal, and the effect of reducing fasting blood glucose in the later period (12 weeks) was also more advantageous; The difference of strain between the two groups after treatment compared with before treatment was statistically significant (P <0.05), compared with the metformin group, the detection value of dominant bacteria such as Bifidobacterium and Lactobacillus was higher in the acarbose group, and the detection value of pathogenic bacteria such as Enterobacteriaceae and Enterococcus was lower. and the differences between the groups were statistically significant (P <0.05). Conclusion For the type 2 diabetes patients with hyperthyroidism, the therapeutic effect of acarbose is better than metformin.

湖南省郴州市科技局立项课题(CZ2014004)