利拉鲁肽对三联治疗后糖化血红蛋白仍不达标2型糖尿病患者的疗效  

Effect of Liraglutide on type 2 diabetes mellitus HbA_(1c) inadequately controlled with three-agent combined treatment

作　　者：陈频[1] 黄勤[1] 

机构地区：[1]第二军医大学附属长海医院,上海200433

出　　处：《中国医药导报》2015年第9期64-68,共5页China Medical Herald

基　　金：全军医学科学技术研究"十二五"计划(编号CW SIIJ254)

摘　　要：目的观察利拉鲁肽对三联治疗后糖化血红蛋白（Hb A1c）仍不达标的2型糖尿病患者的有效性和安全性。方法选择2011年11月~2013年3月就诊于南京军区福州总医院的已应用甘精胰岛素联合促泌剂和二甲双胍、稳定疗程≥2个月但Hb A1c控制仍不佳（9.0%~12.0%）的2型糖尿病患者76例,在保持原治疗方案的基础上分为加用每日1次的利拉鲁肽（利拉鲁肽组,38例）和每日3次的门冬胰岛素（门冬胰岛素组,38例）。于治疗前及治疗24周末检测Hb A1c、空腹血糖（FBG）、餐后2 h血糖（2h PBG）、体重、血压、胰岛素、C肽和血脂等指标。结果治疗24周末,利拉鲁肽组37例及门冬胰岛素组35例完成随访。利拉鲁肽组Hb A1c及Hb A1c≤7%的达标率与门冬胰岛素组比较,差异无统计学意义[（7.0±0.6）%比（6.2±1.2）%、67.6%比65.7%,P〉0.05];利拉鲁肽组30 min胰岛素增量与葡萄糖增量比值（ΔI30/ΔG30）较门冬胰岛素组增高[（6.82±1.70）比（4.96±1.20）,P〈0.05]。利拉鲁肽组胰岛素抵抗指数（HOMA-IR）较门冬胰岛素组降低[（3.17±1.54）比（4.58±1.79）,P〈0.05]。利拉鲁肽组复合终点达标率（Hb A1c≤7%且无低血糖发生及无体重增加）较门冬胰岛素组达标率高（54.3%比35.1%,P〈0.05）。利拉鲁肽组患者对治疗方案的满意度较门冬胰岛素组明显增加（P〈0.05）。结论加用每日1次的利拉鲁肽较每日3次门冬胰岛素对已采用甘精胰岛素联合促泌剂和二甲双胍治疗Hb A1c仍控制不佳的2型糖尿病患者,具有更好的临床效果,患者满意度好。Objective To observe Liraglutide on type 2 diabetes mellitus Hb A1 cinadequately controlled with three-agent combined treatment. Methods From November 2011 to March 2013, in Fuzhou General Hospital of Nanjing Military Command, 76 patients with type 2 diabetes mellitus, and using insulin glargine combined insulin secretagogues agent and metformin, course of treatment ≥2 months, but Hb A1 cinadequately controlled（9.0%-12.0%）. The patients keeped the original treatment, and bases on it, patients were given Liraglutide once/d（Liraglutide group, 38 cases） and insulin aspart 3 times/d（insulin aspart group, 38 cases）, Hb A1 c, FBG, 2h PBG, body weight, blood pressure, lipid and so on were arranged to measured before treatment and after 24 weeks treatment. Results After 24 weeks treatment, there were37 patients in Liraglutide group, 35 patients in insulin aspart group. The differences of the success rate of Hb A1 cand Hb A1c≤7% between Liraglutide group and insulin aspart group [（7.0±0.6）% vs（6.2±1.2）%,（67.6% vs 65.7%）, P〈0.05）],（ΔI30/ΔG30） in liraglutide group was significantly higher than that in insulin aspart group [（6.82±1.70） vs（4.96±1.20）, P〈0.05]. HOMA-IR in liraglutide group was significantly lower than that in insulin aspart group [（3.17±1.54） vs（4.58±1.79）,P〈0.05]. The composite endpoint subjects reaching percentage（Hb A1c≤7% with no hypoglycemia and no weight gain）in Liraglutide group was significantly higher than that in Insulin aspart group（54.3% vs 35.1%, P〈0.05）. The degree of satisfaction in Liraglutide group was significantly higher than that in insulin aspart group（P〈0.05）. Conclusion Compared with insulin aspart,Liraglutide plays a good efficacy and degree of satisfaction in patients with type 2diabetes mellitus and Hb A1 cinadequately controlled on insulin glargine combined insulin secretagogues agent and metformin.

关 键 词：2型糖尿病 利拉鲁肽 门冬胰岛素 疗效 满意度 

分 类 号：R587.1[医药卫生—内分泌]