利拉鲁肽和门冬胰岛素30对肥胖2型糖尿病患者疗效和β细胞功能影响的比较  

Efficacy and effect on β cell functions comparison between liraglutide and biphasic insulin aspart 30 in obese patients with type 2 diabetes mellitus

作　　者：严率[1] 李娜[1] 顾丽萍[1] 顾鸣宇[1] 赵立[1] 彭永德[1] 

机构地区：[1]上海交通大学附属第一人民医院内分泌代谢科,上海200080

出　　处：《世界临床药物》2014年第11期665-669,共5页World Clinical Drug

基　　金：国家自然科学基金(编号:81100616)

摘　　要：目的比较利拉鲁肽和门冬胰岛素30分别与二甲双胍联合对肥胖2型糖尿病患者的疗效和β细胞功能的影响。方法将65例新诊断以及口服降糖药物效果欠佳的肥胖2型糖尿病患者,分为利拉鲁肽组[利拉鲁肽联合二甲双胍(n=30)]和门冬胰岛素30组[门冬胰岛素30联合二甲双胍治疗(n=35)],均治疗12周。分别测定所有对象治疗前后的体重(BW)、体重指数(BMI)、空腹血糖(FPG)、餐后2 h血糖(PPG)、糖化血红蛋白(Hb A1c)、糖化白蛋白(GA)、血清总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白-胆固醇(LDL-C)、高密度脂蛋白-胆固醇(HDL-C)、血清空腹C肽(FCP)、餐后2 h C肽(PCP)等指标,并计算β细胞功能指数(HOMA-β)和胰岛素抵抗指数(HOMA-IR)。比较各组治疗前后及两组间各项指标变化情况。结果利拉鲁肽组治疗12周后BW及BMI均较治疗前下降(P<0.01),与门冬胰岛素30组相比差异具有统计学意义(P<0.01)。两组治疗后FPG、PPG、Hb A1c和GA均较治疗前下降(P<0.01)。利拉鲁肽组治疗后FCP、PCP和HOMA-IR较治疗前下降(P<0.05),HOMA-β上升(P<0.01);而门冬胰岛素30组治疗后FCP和PCP较治疗前上升(P<0.05),HOMA-β上升(P<0.01)。两组治疗后HOMA-IR下降差异具有统计学意义(P<0.05)。利拉鲁肽组治疗后TC、TG及LDL-C较治疗前下降(P<0.05);而门冬胰岛素30组治疗后TC和LDL-C较治疗前下降(P<0.05)。结论利拉鲁肽或门冬胰岛素30联合二甲双胍治疗对肥胖2型糖尿病患者的血糖指标控制均有效,并均可改善其β细胞功能。但在控制体重及改善胰岛素抵抗方面,利拉鲁肽更优于门冬胰岛素30。Abstract： Objective To compare the efficacy on β cell function between liraglutide and biphasic insulin aspart 30 （BIAsp 30） in obese type 2 diabetic patients. Methods Sixty five obese type 2 diabetic patients, who were newly diagnosed or inadequately glycemic controlled with oral antidiabetic agents, were assigned to liraglutide group （n=30） or BIAsp 30 group （n=35）. The patients were received metformin （1 500 mg/d ） and liraglutide （1.2 mg/d ） in liraglutide group and metformin （ 1 500 mg/d ） and insulin aspart 30 （ twice a day ） in BIAsp 30 group for 12 weeks. Body weight （BW）, body mass index （BMI）, fasting plasma glucose （FPG）, 2 hour postprandial glucose （PPG）, the haemoglobin Ale （HbAlc）, glycated albumin （GA）, total cholesterol（TC）, triglyceride（TG）, low density lipoprotein cholesterol （LDL-C）, high density lipoprotein cholesterol （HDL-C）, serum fasting C-peptide （FCP） and 2-hour postprandial C-peptide （PCP） were tested on baseline and after treatment. β cell function index （HOMA-β） and insulin resistance index （HOMA-IR） were calculated. Results After treatment, BW and BMI were significantly decreased in liraglutide group （P〈0.01）, and were decreased more significantly in liraglutide group than in BIAsp 30 group （P〈0.01）. FPG, PPG, HbA lc, GA were significantly decreased in both groups after treatment compared with before treatment （P〈0.01）. After treatment, FCP, PCP, HOMA-IR were decreased （P〈0.05）, while HOMA-β were increased （P〈0.01） in liraglutide group. In BIAsp 30 group, FCP, PCP were increased （P〈0.05） and HOMA-β were also significant increased （P〈0.01）. HOMA-IR were decreased more significantly in liraglutide group than in BIAsp 30 group （P〈0.01）. After treatment, TC, TG, LDL-C were decreased in liraglutide group （P〈0.05）. TC, LDL-C were decreased in BIAsp 30 group （P〈0.05）. Conclusion Combination therapy of metformin with liraglutide or insulin asp

关 键 词：2型糖尿病 肥胖 胰高糖素样肽-1 利拉鲁肽 门冬胰岛素30 

分 类 号：R587.1[医药卫生—内分泌] R977.15[医药卫生—内科学]