二甲双胍联合利拉鲁肽对2型糖尿病同型半胱氨酸等心血管危险因素的影响  

Effect of liraglutide on homocysteine and other cardiovascular markers in type 2 diabetes mellitus

作　　者：郭剑津[1] 任伟 秦洁[3] 于翰[3] 郗光霞 李兴[1] 柳洁[3] 

机构地区：[1]山西医科大学第二医院内分泌科,太原030001 [2]山西大医院内分泌科 [3]山西省人民医院内分泌科

出　　处：《中华临床医师杂志（电子版）》2015年第1期56-59,共4页Chinese Journal of Clinicians(Electronic Edition)

基　　金：中国博士后基金(2012M510850);国家自然科学基金青年基金(81400836)

摘　　要：目的：观察比较胰高血糖素样肽1（GLP-1）类似物利拉鲁肽以及格列美脲干预治疗2型糖尿病后血糖水平及心血管相关标志物水平变化。方法48例新诊断糖尿病患者，近3个月使用二甲双胍单药治疗达1500 mg且血糖控制不佳的2型糖尿病患者为研究对象，随机分为两组：分别加用利拉鲁肽皮下注射（0.6～1.2 mg/d）或格列美脲（2～4 mg/d）。治疗24周后，观察体重、血压、血糖、血脂改变，超声观察颈动脉内膜中层厚度CIMT变化、同型半胱氨酸（Hcy）、C反应蛋白（CRP）、Ⅰ型血浆纤溶酶原活化抑制剂（PAI-1）、甘露糖结合凝集素（MBL）、基质金属蛋白酶-9（MMP-9）水平。结果与治疗前相比，两组患者治疗后血糖及糖化血红蛋白（HbA1c）水平均显著降低（P＜0.01或P＜0.05），但两组间无显著性差异。利拉鲁肽组体重较治疗前减轻，而格列美脲组无明显变化。两组患者收缩压及舒张压均有下降，但无统计学意义（P＞0.05）。两组Hcy、CRP、PAI-1、MBL、MMP-9等血浆心血管标志物下降，但利拉鲁肽组明显优于格列美脲组（P＜0.01）。结论利拉鲁肽降糖效果与格列美脲相当，但其可有效降低体重并影响心血管相关危险因素水平，对心血管可能具有保护作用。Objective To investigate the levels of markers for cardiovascular disease in type 2 diabetes mellitus and the effect of glimepiride and liraglutide which is a long-acting human glucagon-like peptide-1 （GLP-1） analog on these markers. Methods This study included 48 T2DM patients had been treated with poorly controlled diabetes using metformin （1 500 mg） in the latest 3 months. The patients were randomly divided into the treatment groups of glimepiride （2-4 mg/d） or liraglutide （0.6-1.2 mg/d） for 24 weeks. The body weight, blood pressure, glucose, lipids and the markers for cardiovascular disease including serum C-reactive protein （CRP）, plasminogen activator inhibitor type-1 （PAI-1）, mannose binding lectin （MBL）, serum matrix metalloproteinase-9 （MMP-9）, homocysteine （Hcy） and carotid intima media thickness （CIMT） were detected at the 24 weeks after the patients being treated. Results The level of blood sugar and HbA1c decreased in both groups （P〈0.01 or P〈0.05） after treatment, but there was no significant difference between two groups （P〉0.05）. Significant average weight loss compared with baseline was seen in liraglutide group （P〈0.01）, while there was no significant improvement in glimepiride group （P〉0.05）. The levels of Hcy, CRP, PAI-1, MBL, MMP-9 were dramatically reduced after administration of liraglutide and glimepiride group, but the effect of liraglutide was significantly superior to glimepiride （P〈0.01）. Conclusion Liraglutide had similar blood glucose lowering effect as glimepiride. Liraglutide decreases body weight effectively and have protective effect on macrovascular diseases through＆amp;nbsp;inhibition of theses markers.

关 键 词：胰高血糖素样肽1 糖尿病 2型 糖尿病血管病变 利拉鲁肽 

分 类 号：R587.1[医药卫生—内分泌]