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"paragraph": "随着社会经济的发展，糖尿病患病率逐渐增加，已成为严重的世界性问题。糖尿病特别是其慢性并发症影响患者的生活质量，甚至威胁患者的生命，给社会、家庭以及患者带来沉重的经济负担。中国的流行病学调查显示，中国20岁以上人群2型糖尿病患病率达9.7%；且近2/3的患者HbA1c得不到有效控制(HbA1c≤7%)；60.7%的患者因未被诊断而无法及早进行有效的治疗和指导。",
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"paragraph": "美国大学组糖尿病研究项目(UGDP)研究提出，甲苯磺丁脲可能增加2型糖尿病患者心血管死亡风险。但UKPDS、ADOPT及ADVANCE并未发现格列本脲和格列齐特缓释片增加心血管风险(1b级，2b级)。",
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"tail_entity_id": "T294"
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"relation_type": "Drug_Disease",
"relation_id": "R118",
"head_entity_id": "T287",
"tail_entity_id": "T288"
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"relation_type": "Class_Disease",
"relation_id": "R119",
"head_entity_id": "T289",
"tail_entity_id": "T288"
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"relation_type": "Class_Disease",
"relation_id": "R120",
"head_entity_id": "T291",
"tail_entity_id": "T290"
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"relation_type": "Test_items_Disease",
"relation_id": "R121",
"head_entity_id": "T292",
"tail_entity_id": "T290"
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"paragraph": "2.胰岛素促泌剂的禁忌证：药物过敏、1型糖尿病、糖尿病酮症酸中毒、高糖性高渗透压综合征、严重肝或肾损伤和哺乳期患者等。",
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"end_idx": 8
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"end_idx": 17
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"entity": "1型糖尿病",
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"entity": "1型",
"entity_type": "Class",
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"end_idx": 20
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"entity": "糖尿病酮症酸中毒",
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"end_idx": 32
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"entity_id": "T302",
"entity": "高糖性高渗透压综合征",
"entity_type": "Disease",
"start_idx": 33,
"end_idx": 43
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"entity": "严重肝或肾损伤",
"entity_type": "Disease",
"start_idx": 44,
"end_idx": 51
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{
"entity_id": "T304",
"entity": "肝",
"entity_type": "Anatomy",
"start_idx": 46,
"end_idx": 47
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"entity_id": "T305",
"entity": "肾",
"entity_type": "Anatomy",
"start_idx": 48,
"end_idx": 49
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"relation_id": "R123",
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"relation_id": "R124",
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"tail_entity_id": "T303"
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"relation_id": "R125",
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"paragraph": "3.胰岛素促泌剂的联合用药原则：2型糖尿病患者，若胰岛素促泌剂单药治疗血糖控制不佳，应与其他降糖药物如双胍类、α-糖苷酶抑制剂或噻唑烷二酮类药物联用。",
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"end_idx": 75,
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"entity": "噻唑烷二酮类药物",
"entity_type": "Drug",
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"end_idx": 72
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"entity": "α-糖苷酶抑制剂",
"entity_type": "Drug",
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"end_idx": 63
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"entity": "双胍类",
"entity_type": "Drug",
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"end_idx": 54
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"entity_id": "T309",
"entity": "血糖",
"entity_type": "Test_items",
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"entity": "控制不佳",
"entity_type": "Test_Value",
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"end_idx": 41
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"entity": "2型糖尿病",
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"entity": "2型",
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"end_idx": 18
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"entity": "胰岛素促泌剂",
"entity_type": "Drug",
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"end_idx": 31
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"entity_id": "T314",
"entity": "胰岛素促泌剂",
"entity_type": "Drug",
"start_idx": 2,
"end_idx": 8
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"relation_id": "R126",
"head_entity_id": "T306",
"tail_entity_id": "T311"
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"relation_type": "Drug_Disease",
"relation_id": "R127",
"head_entity_id": "T307",
"tail_entity_id": "T311"
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"relation_type": "Drug_Disease",
"relation_id": "R128",
"head_entity_id": "T308",
"tail_entity_id": "T311"
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"relation_type": "Test_items_Disease",
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"head_entity_id": "T309",
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"relation_id": "R130",
"head_entity_id": "T312",
"tail_entity_id": "T311"
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"relation_id": "R131",
"head_entity_id": "T313",
"tail_entity_id": "T311"
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"paragraph_id": "45",
"paragraph": "联合治疗时应注意以下事项：(1)应选择作用机制互补的降糖药物(5级)；(2)一般联合2种药物，最多可联用3种药物，若血糖仍得不到有效控制，应及时启动胰岛素治疗(5级)；(3)联合用药应考虑价效因素，尽量减轻患者经济负担；(4)磺脲类促泌剂与格列奈类促泌剂虽然在分子结构和作用靶位上存在不同，但两者合用的临床证据尚不充分，一般不推荐两者联用。",
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"entity_id": "T315",
"entity": "血糖",
"entity_type": "Test_items",
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"end_idx": 60
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"entity": "得不到有效控制",
"entity_type": "Test_Value",
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"end_idx": 68
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"entity": "胰岛素",
"entity_type": "Drug",
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"end_idx": 77
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"entity": "磺脲类促泌剂",
"entity_type": "Drug",
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"paragraph": "二、不同血糖谱的选药原则",
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"paragraph": "在选择胰岛素促泌剂治疗时，可根据患者血糖选择不同类型胰岛素促泌剂(5级)：(1)以餐后血糖(PPG)升高为主者，宜选择格列吡嗪、格列奈类促泌剂；(2)以空腹血糖(FPG)升高为主者，宜选择依从性好、低血糖发生风险低的中长效磺脲类促泌剂；(3)餐后血糖和空腹血糖均升高者，宜选择依从性好、低血糖发生风险低的中长效磺脲类促泌剂。",
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"entity": "胰岛素促泌剂",
"entity_type": "Drug",
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"end_idx": 9
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"end_idx": 20
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"entity_id": "T323",
"entity": "胰岛素促泌剂",
"entity_type": "Drug",
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"entity": "餐后血糖(PPG)",
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"entity_id": "T325",
"entity": "升高",
"entity_type": "Test_Value",
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"entity": "格列吡嗪",
"entity_type": "Drug",
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"entity_id": "T327",
"entity": "格列奈类促泌剂",
"entity_type": "Drug",
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"end_idx": 71
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"entity": "空腹血糖(FPG)",
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"end_idx": 85
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"entity": "升高",
"entity_type": "Test_Value",
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"end_idx": 87
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"entity": "低血糖",
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"end_idx": 102
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"entity": "中长效磺脲类促泌剂",
"entity_type": "Drug",
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"end_idx": 117
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"entity": "餐后血糖",
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"entity": "空腹血糖",
"entity_type": "Test_items",
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"entity": "升高",
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"entity": "低血糖",
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"entity": "中长效磺脲类促泌剂",
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"relation_id": "R132",
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"paragraph": "三、老年糖尿病患者(≥65岁)",
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"sentence": "三、老年糖尿病患者(≥65岁)",
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"entity": "糖尿病",
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"paragraph": "老年患者应根据脏器功能、认知功能以级预期寿命选择不同胰岛素促泌剂治疗，但总体而言，治疗措施应尽量简单易行，并充分考虑肝肾功能减退程度(5级)。若患者既往有严重低血糖史、合并其他严重疾病、预期生存期较短，宜选择作用时间较短的格列奈类促泌剂；若患者脏器功能和认知能力良好、预期生存期较长，可选择低血糖少等安全性较好的磺脲类促泌剂。",
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"entity": "严重",
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"entity": "低血糖",
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"entity": "格列奈类促泌剂",
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"entity": "低血糖",
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"entity": "磺脲类促泌剂",
"entity_type": "Drug",
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"paragraph": "四、低血糖高危险人群",
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"paragraph": "糖尿病病程长(>15年)、有“无感知”低血糖病史、存在肝肾功能不全或全天血糖波动较大并反复出现低血糖症状的患者给予胰岛素促泌剂治疗时，应选择格列奈类促泌剂或低血糖风险较低的磺脲类促泌剂(1b级，5级)；一般应小剂量开始使用。",
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"entity": "肝",
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"entity": "肾",
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"entity": "低血糖",
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"entity": "胰岛素促泌剂治",
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"paragraph": "五、其他情况",
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"paragraph": "目前关于妊娠期糖尿病或妊娠期显性糖尿病或孕前2型糖尿病患者妊娠期间及哺乳期使用胰岛素促泌剂的临床证据尚不太充分，一般情况下国内不推荐孕妇及哺乳期患者应用胰岛素促泌剂治疗。",
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"entity": "2型",
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"paragraph": "对伴有中度肾功能不全患者，应首选胰岛素，也可选择经肾排泄少的胰岛素促泌剂，如瑞格列奈或格列喹酮，并根据肾功能水平适当降低胰岛素促泌剂的使用剂量。",
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"paragraph": "对短期接受胰岛素强化治疗后的患者，可选择胰岛素促泌剂治疗。",
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"paragraph": "对依从性差的患者，尤其是在中国农村地区的患者，宜选择低血糖风险低、对体重影响小及廉价的1日1次磺脲类促泌剂(4级)。",
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"paragraph": "迄今为止，胰岛素促泌剂在2型糖尿病治疗中仍占据不可或缺的地位，为多数权威2型糖尿病防治指南中的一线降糖药物。中国成人2型糖尿病患者体重指数较低、糖尿病肾病发生率较高且β细胞胰岛素分泌功能比胰岛素敏感性降低更明显，胰岛素促泌剂更符合中国成人2型糖尿病患者特点。磺脲类药物，经长时间应用及大型临床研究证实，降糖疗效肯定且降HbA1c作用强、安全性高，可减少微血管并发症的发生，早期使用还可减少大血管并发症和全因死亡的发生。格列奈类有效降低餐后血糖，在中国也广泛使用。由于患者的耐受性、依从性及经济条件差别较大，因此，在临床实践中应根据患者特点，选用合适的胰岛素促泌剂。",
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"paragraph": "优化的降糖治疗不仅只针对胰岛素分泌缺陷，还应同时关注其他发病机制(如胰岛素抵抗、能量摄取等)。胰岛素促泌剂与其他作用机制互补的药物联用，可多方面干预糖尿病发病环节，使患者血糖得到长期、有效、平稳及安全的控制。",
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"entity_type": "Pathogenesis",
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"entity": "胰岛素抵抗",
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},
{
"entity_id": "T420",
"entity": "能量摄取",
"entity_type": "Pathogenesis",
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},
{
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"entity": "胰岛素促泌剂",
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},
{
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"entity": "糖尿病",
"entity_type": "Disease",
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"end_idx": 77
},
{
"entity_id": "T423",
"entity": "血糖",
"entity_type": "Test_items",
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}
],
"relations": [
{
"relation_type": "Drug_Disease",
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},
{
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]
}
]
}
] |
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