目的 探討甘精胰島素注射液聯(lián)合格列美脲片和阿卡波糖片治療磺脲類藥物治療失效的2型糖尿病的臨床療效。方法 選取2014年10月-2016年6月中山大學附屬第三醫(yī)院粵東醫(yī)院內(nèi)分泌科收治的磺脲類藥物治療失效的2型糖尿病患者136例，按照治療方案的不同分為甘精胰島素聯(lián)合格列美脲組（44例）、甘精胰島素聯(lián)合阿卡波糖組（43例）、甘精胰島素聯(lián)合格列美脲和阿卡波糖組（49例）。甘精胰島素聯(lián)合格列美脲組每日晚餐后皮下注射甘精胰島素注射液，起始劑量10 U/d；晚餐后30 min口服格列美脲片2 mg。甘精胰島素聯(lián)合阿卡波糖組每日晚餐后皮下注射甘精胰島素注射液，起始劑量10 U/d；口服阿卡波糖片50 mg，3次/d；甘精胰島素聯(lián)合格列美脲和阿卡波糖組每日晚餐后皮下注射甘精胰島素，起始劑量10 U/d；晚餐后30 min口服格列美脲片2 mg；口服阿卡波糖片50 mg，3次/d。治療3個月后比較各觀察指標。結(jié)果 治療后，3組空腹血糖（FBG）、餐后2 h血糖（2hPG）、糖化血紅蛋白（HbA1c）水平均降低（P<0.05），且甘精胰島素聯(lián)合格列美脲和阿卡波糖組血糖指標改善優(yōu)于甘精胰島素聯(lián)合格列美脲組、甘精胰島素聯(lián)合阿卡波糖組（P<0.05）。治療后，3組穩(wěn)態(tài)模型評估胰島素抵抗指數(shù)（HOMA-IR）降低，胰島β細胞功能指數(shù)（HOMA-β）、餐后2 h胰島素、餐后2 h C-肽均升高（P<0.05），且甘精胰島素聯(lián)合格列美脲和阿卡波糖組胰島功能改善優(yōu)于甘精胰島素聯(lián)合格列美脲組、甘精胰島素聯(lián)合阿卡波糖組（P<0.05）。甘精胰島素聯(lián)合格列美脲和阿卡波糖組血糖達標時間短于甘精胰島素聯(lián)合格列美脲組、甘精胰島素聯(lián)合阿卡波糖組（P<0.05），胰島素日用量低于甘精胰島素聯(lián)合格列美脲組、甘精胰島素聯(lián)合阿卡波糖組（P<0.05），低血糖發(fā)生率低于甘精胰島素聯(lián)合格列美脲組（P<0.05），而與甘精胰島素聯(lián)合阿卡波糖組差異無統(tǒng)計學意義。結(jié)論 甘精胰島素注射液聯(lián)合格列美脲片和阿卡波糖片治療磺脲類藥物治療失效的2型糖尿病可有效控制血糖水平，縮短血糖達標時間，且不增加低血糖發(fā)生率，具有一定的臨床推廣應用價值。

Objective To explore the clinical curative effect of Insulin Glargine Injection combined with Glimepiride Tablets and Acarbose Tablets in treatment of type 2 diabetes with sulfonylurea treatment failure. Methods Patients (136 cases) with type 2 diabetes with sulfonylurea treatment failure in Department of Endocrine of The Third Affiliated Hospital, Sun Yat-Sen University, Yuedong Hospital from June 2014 to June 2016 were divided into insulin glargine combined with glimepiride (44 cases), glargine combined with acarbose (44 cases), and insulin glargine combined with glimepiride and acarbose (49 cases) groups based on different treatments. The patients in the insulin glargine combined with glimepiride group were sc administered with Insulin Glargine Injection with initial dosage of 10 U/d after supper, and were also po administered with Glimepiride Tablets 2 mg at 30 min after supper. The patients in the insulin glargine combined with acarbose group were sc administered with Insulin Glargine Injection with initial dosage of 10 U/d after supper, and were also po administered with Acarbose Tablets 50 mg, three times daily. The patients in the insulin glargine combined with glimepiride and acarbose group were sc administered with Insulin Glargine Injection with initial dosage of 10 U/d after supper, were po administered with Glimepiride Tablets 2 mg at 30 min after supper, and were also po administered with Acarbose Tablets 50 mg, three times daily. After treatment for three months, the clinical indexes in three groups were observed. Results After treatment, levels of FBG, 2hPG, and HbA1c in three groups were significantly decreased (P<0.05), and the blood glucose indexes in the insulin glargine combined with glimepiride and acarbose group were significantly better than those in the insulin glargine combined with glimepiride and insulin glargine combined with acarbose group (P<0.05). After treatment, HOMA-IR in three groups were significantly decreased, but HOMA-β, postprandial 2 h insulin, and postprandial 2 h C-peptide were significantly increased (P<0.05), and the islet function indexes in the insulin glargine combined with glimepiride and acarbose group were significantly better than those in the insulin glargine combined with glimepiride and insulin glargine combined with acarbose group (P<0.05). Blood sugar up to the standard times in the insulin glargine combined with glimepiride and acarbose group were shorter than those in the insulin glargine combined with glimepiride and insulin glargine combined with acarbose group (P<0.05). The daily doses of insulin in the insulin glargine combined with glimepiride and acarbose group were lower than those in the insulin glargine combined with glimepiride and insulin glargine combined with acarbose group (P<0.05). The incidences of hypoglycemia in the insulin glargine combined with glimepiride and acarbose group were lower than those in the insulin glargine combined with glimepiride group (P<0.05), but there was no significant difference with those in the insulin glargine combined with acarbose group. Conclusion Insulin Glargine Injection combined with Glimepiride Tablets and Acarbose Tablets can effectively control the blood glucose level, shorten the time of blood glucose, and do not increase incidence of hypoglycemia in the treatment of type 2 diabetes with sulfonylurea treatment failure, which has a certain clinical application value.