度拉糖肽联合卡格列净对早期血糖控制不佳超重型T2DM患者的疗效  

Evaluation of the Effect of Dulaglutide Combined with Canagliflozin on Super Severe T2DM Patients with Poor Early Blood Glucose Control

作　　者：张南[1] 王琛惠 郭倩倩[1] 葛春丽 杨敬随 杨庆宇 ZHANG Nan;WANG Chenhui;GUO Qianqian;GE Chunli;YANG Jingsui;YANG Qingyu(Department of Pharmacy,the Fifth Clinical Medical College of Henan University of Chinese Medicine(Zhengzhou People’s Hospital),Zhengzhou 450003,China;Department of Endocrinology,the Fifth Clinical Medical College of Henan University of Chinese Medicine(Zhengzhou People’s Hospital),Zhengzhou 450003,China)

机构地区：[1]河南中医药大学第五临床医学院(郑州人民医院)药学部,河南郑州450003 [2]河南中医药大学第五临床医学院(郑州人民医院)内分泌代谢科,河南郑州450003

出　　处：《河南医学研究》2024年第13期2421-2426,共6页Henan Medical Research

基　　金：河南省医学科技攻关计划(联合共建)项目(LHGJ20210705);河南中医药大学科研苗圃工程项目(MP2022-33)。

摘　　要：目的评价度拉糖肽联合卡格列净对早期血糖控制不佳超重型2型糖尿病(T2DM)患者的临床治疗效果。方法研究对象为2021年7月至2022年12月在郑州人民医院内分泌代谢科收治的口服联合降糖方案血糖控制不好的超重型T2DM患者120例,随机分为试验组和对照组,每组60例。试验组以周制剂度拉糖肽联合卡格列净治疗,对照组给予14 d胰岛素泵治疗至血糖稳定后,改用门冬胰岛素30注射液。经3个月治疗后,比较两种不同治疗策略的临床效果。包括临床疗效、血糖情况、胰岛功能、体格检查指标、血脂情况、血清因子[中性粒细胞与淋巴细胞比值(NLR)、C反应蛋白(CRP)、谷胱甘肽过氧化物酶(GSH-Px)及超氧化物歧化酶(SOD)]水平比较,分析GSH-Px、SOD分别与NLR及CRP间的相关性;并对比其诊疗过程中发生的不良反应。结果共剔除患者16例,最终纳入统计学分析病例包括试验组52例,对照组52例。两组空腹血糖(FPG)、餐后2 h血糖(2 h PG)及糖化血红蛋白(HbA1c)、胰岛素抵抗指数(HOMA-IR)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL-C)、NLR及CRP水平与治疗前相比均降低,空腹胰岛素(FINS)、稳态模型胰岛β细胞功能指数(HOMA-β)、空腹C肽(FCP)、高密度脂蛋白(HDL-C)、GSH-Px及SOD水平与治疗前相比均增加,且试验组优于对照组,差异有统计学意义(P<0.05)。Pearson分析可知,GSH-Px与NLR、CRP及NLR与SOD均呈负相关。治疗过程中,试验组不良反应发生率为19.23%(10/52),对照组为36.54%(19/52),试验组低于对照组,差异有统计学意义(χ^(2)=3.873,P<0.05)。结论度拉糖肽联合卡格列净对于早期血糖控制不佳超重型T2DM患者较胰岛素表现出更好的临床治疗效果,值得临床推广应用。Objective To evaluate the clinical effect of dulaglutide combined with canagliflozin on super severe type 2 diabetes mellitus(T2DM)patients with poor early blood glucose control.Methods The study object was 120 patients with super severe T2DM who were admitted to the Endocrine Metabolism Department of hospital from July 2021 to December 2022 with oral combined hypoglycemic regimen and poor blood glucose control.They were randomly divided into the test group and the control group,with 60 patients in each group.The test group was treated with weekly dulaglutide combined with canagliflozin,and the control group was treated with insulin pump for 14 days until the blood sugar was stable,and then changed to insulin aspart 30 injection.After 3 months of treatment,the clinical effects of two different treatment strategies were compared by univariate method,involving comparison of clinical efficacy,blood glucose,islet function,physical examination index,blood lipid,serum factors[neutrophil-lymphocyte ratio(NLR),C-reactive protein(CRP),glutathione peroxidase(GSH-Px)and superoxide dismutase(SOD)].The correlation between GSH-Px,SOD and NLR and CRP was analyzed.Compared the adverse reactions occurred in the course of diagnosis and treatment.Results A total of 16 patients were excluded,and the final cases included in the statistical analysis included 52 in the test group and 52 in the control group.After treatment,the fasting plasma glucose(FPG),2-hour postprandial blood glucose(2 h PG)and hemoglobin A1c(HbA1c),homeostasis model assessment of insulin resistance(HOMA-IR),total cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C),NLR and CRP were significantly decreased,while the levels of fasting insulin(FINS),homeostasis model assessment of beta-cell function(HOMA-β),fasting C-peptide(FCP),high-density lipoprotein cholesterol(HDL-C),GSH-Px and SOD were significantly increased,and the test group was better than the control group(P<0.05).Pearson analysis showed that GSH-Px were negatively correlated with

关 键 词：度拉糖肽 卡格列净 超重 2型糖尿病 

分 类 号：R979.9[医药卫生—药品]