利拉鲁肽与达格列净联用治疗肥胖2型糖尿病的疗效及对机体胰岛功能的影响  

Efficacy of liraglutide combined with dapagliflozin on patients with obesity and type 2 diabetesmellitus and its effects on islet function

作　　者：孙明慧 王坤[1] Sun Minghui;Wang Kun(Department of Endocrinology,Liaocheng People’s Hospital,Liaocheng 252000,China)

机构地区：[1]山东省聊城市人民医院内分泌科,252000

出　　处：《中国实用医刊》2021年第20期91-95,共5页Chinese Journal of Practical Medicine

摘　　要：目的探讨利拉鲁肽与达格列净联用治疗肥胖2型糖尿病(T2DM)的效果以及对机体胰岛功能的影响。方法抽取2018年12月至2020年12月聊城市人民医院收治的116例肥胖T2DM患者, 采用随机数字表法分为联合组和对照组, 每组58例, 两组均给予二甲双胍口服, 0.5 g/次, 3次/d, 并于睡前采用利拉鲁肽皮下注射, 起始剂量0.6 mg/d, 1周后根据患者反应增加至1.2 mg/d, 联合组另加用达格列净口服治疗, 剂量为10 mg/次, 1次/d, 同时嘱患者合理饮食并适当运动, 两组疗程均为3个月, 治疗前后血糖、血脂、体质量以及胰岛功能等相关指标变化情况。结果治疗3个月时两组空腹血糖(FPG)、餐后2 h血糖(2hPG)及糖化血红蛋白(HbA1c)水平均降低(P<0.05), 且联合组FBG、2hPG及HbA1c低于对照组;两组体质指数(BMI)和腰臀比均降低, 且联合组BMI和腰臀比低于对照组;两组血清三酰甘油(TG)、总胆固醇(TC)及低密度脂蛋白胆固醇(LDL-C)水平均降低(P<0.05), 两组血清高密度脂蛋白胆固醇(HDL-C)水平升高(P<0.05), 且联合组血清TG、TC和LDL-C水平低于对照组, 血清HDL-C水平高于对照组;两组空腹胰岛素(FINS)和胰岛β细胞功能指数(HOMA -β)均升高, 两组胰岛素抵抗指数(HOMA-IR)均降低, 且联合组FINS和HOMA -β均高于对照组, HOMA-IR低于对照组(P<0.05)。治疗期间两组不良反应发生率分别为15.52%和12.07%(P>0.05)。结论利拉鲁肽与达格列净联合用于肥胖T2DM患者治疗有利于改善糖脂代谢并降低患者体质量, 且短期治疗具有良好安全性。Objective To explore the efficacy of liraglutide combined with dapagliflozin in the treatment of patients with obesity and type 2 diabetes mellitus(T2DM)and its effects on islet function.Methods A total of 116 patients with obesity and T2DM in Liaocheng People’s Hospital from December 2018 to December 2020 were divided into combined group and control group according to the random number table method,with 58 cases in each group.Both groups were given oral metformin(0.5 g/time,3 times/d),and received subcutaneous injection of liraglutide before going to bed with an initial dose of 0.6 mg/d which was increased to 1.2 mg/d according to the patients’response 1 week later.Patients in combined group were additionally treated with oral dapagliflozin(10 mg/time,1 time/d),and were instructed to eat a reasonable diet and exercise properly,and the two groups were treated for 3 months.The changes of blood glucose,blood lipids,body weight and islet function were compared before and after treatment.Results At 3 months of treatment,the levels of fasting plasma glucose(FPG),2 h postprandial blood glucose(2hPG)and glycosylated hemoglobin(HbA1c)in the two groups were significantly reduced(P<0.05),and the FBG,2hPG and HbA1c of combined group were lower than those of control group.The body mass index(BMI)and waist-to-hip ratio of the two groups were significantly reduced,and the BMI and waist-to-hip ratio of combined group were lower than those of control group.The levels of serum triglyceride(TG),total cholesterol(TC)and low density lipoprotein-cholesterol(LDL-C)in the two groups were significantly decreased(P<0.05),while the level of serum high density lipoprotein-cholesterol(HDL-C)was significantly increased(P<0.05),and the levels of serum TG,TC and LDL-C in combined group were lower than those in control group while the level of serum HDL-C was higher than that in control group.The fasting insulin(FINS)and isletβcell function index(HOMA-β)of the two groups were significantly increased while the insulin resistance index(HOMA

关 键 词：2型糖尿病 肥胖 利拉鲁肽 达格列净 

分 类 号：R587.1[医药卫生—内分泌]