利拉鲁肽联合二甲双胍对糖尿病合并冠心病患者血清趋化素及胰岛素抵抗的影响  

Influence of liraglutide combined with metformin on serum chemokine and insulin resistance in patients with diabetes accompanied by coronary heart disease

作　　者：郭洁[1] 张玉[2] 孙耀东[1] 贾万明[1] 边亚 王雅依[3] Guo Jie;Zhang Yu;Sun Yaodong;Jia Wanming;Bian Ya;Wang Yayi(Department of Cardiovascular Medicine,Second Hospital of Shijiazhuang City,Shijiazhuang 050000,China)

机构地区：[1]石家庄市第二医院心血管内科,石家庄050000 [2]河北省石家庄市第一医院老年内科,石家庄050000 [3]河北医科大学附属第二医院全科医学科,石家庄050000

出　　处：《中国循证心血管医学杂志》2019年第2期212-214,218,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：石家庄市科学技术研究与发展计划(161462683)

摘　　要：目的研究利拉鲁肽联合二甲双胍对糖尿病合并冠状动脉粥样硬化性心脏病(冠心病患者血清趋化素及胰岛素抵抗的影响。方法选取2016年2月至2017年4月于石家庄市第二医院心血管内科治疗的糖尿病合并冠心病患者80例,随机分为对照组和研究组,每组各40例,对照组在常规治疗基础上加二甲双胍治疗,研究组在常规治疗基础上应用利拉鲁肽联合二甲双胍联合治疗,治疗4周后分析两组患者血糖、心功能、血清趋化素、胰岛素抵抗及不良反应间的差异。结果研究组患者的空腹血糖(t=2.27,P=0.03)、餐后2 h血糖(t=2.04,P=0.04)、糖化血红蛋白(t=3.32,P=0.0001)、血清趋化素(t=14.15,P<0.01)和稳态模型IR指数HOMA-IR(t=5.59,P<0.01)及胰岛β细胞功能指数(HOMA-β,t=4.29,P<0.01)的控制效果显著优于对照组,从患者的心脏功能而言,患者的左心室射血分数(LVEF,t=11.53,P<0.01),左心室收缩末期的内径大小(LVESD,t=9.46,P<0.01),左心室舒张末期的内径大小(LVEDD,t=4.85,P<0.01)的改善优于对照组,从安全角度分析,两组患者的不良反应之间的差异不存在统计学意义。结论利拉鲁肽和二甲双胍联合应用,不仅对糖尿病合并冠心病患者的血糖,血清趋化因子及胰岛素抵抗等情况有明显改善,且对患者的心功能起到最大程度的保护作用,值得在临床进行推广。Objective To study the influence of liraglutide combined with metformin on serum chemokine and insulin resistance(IR)in patients with diabetes accompanied by coronary heart disease(CHD).Methods The patients(n=80)were chosen from Department of Cardiovascular Medicine of the Second Hospital of Shijiazhuang City from Feb.2016 to Apr.2017,and divided randomly into control group and study group(each n=40).The control group was treated with routine therapy and metformin,and study group was treated with liraglutide combined with metformin on the basis of routine therapy.After treatment for 4 weeks,the difference in blood sugar,heart function,serum chemokine,IR and adverse reactions were analyzed between 2 groups.Results The control effects on fasting plasma glucose(FPG,t=2.27,P=0.03),2-hour postprandial blood glucose(2 hPBG,t=2.04,P=0.04),glycated hemoglobin(HbAlc,t=3.32,P=0.0001),serum chemokine(t=14.15,P<0.01),homeostasis model assessment of insulin resistance(HOMA-IR,t=5.59,P<0.01)and HOMA-β(t=4.29,P<0.01)were significantly higher in study group than those in control group.The improving effects on left ventricular ejection fraction(LVEF,t=11.53,P<0.01),left ventricular end-systolic diameter(LVESd,t=9.46,P<0.01)and left ventricular end-diastolic inner diameter(LVEDd,t=4.85,P<0.01)were higher in study group than those in control group.The difference in adverse reactions had no statistical significance between 2 groups.Conclusion Liraglutide combined with metformin can not only improve blood sugar,serum chemokine and IR,but also protect heart function in patients with diabetes accompanied by CHD,which is worthy of clinic application.

关 键 词：利拉鲁肽 二甲双胍 糖尿病合并冠心病 血清趋化素 胰岛素抵抗 

分 类 号：R541.4[医药卫生—心血管疾病]