利拉鲁肽辅助治疗调控初发2型糖尿病伴肥胖患者代谢紊乱的效果研究  

Study on the effect of liraglutide as an adjunct therapy in regulating metabolic disorders in obese patients with newly diagnosed type 2 diabetes

作　　者：曾海勇[1] 李海燕[1] 陈淑娟[1] 刘雪婷 汪新宇[1] 陈泽龙[1] 刘明铭[1] 吕凌波[1] 阎德文[1] ZENG Hai-yong;LI Hai-yan;CHEN Shu-juan;LIU Xue-ting;WANG Xin-yun;CHEN Ze-long;LIU Ming-ming;LYU Ling-bo;YAN De-wen(Department of Endocrinology,Shenzhen Second People′s Hospital(the First Affiliated Hospital of Shenzhen University),Shenzhen 518035,Guangdong,China)

机构地区：[1]深圳市第二人民医院(深圳大学第一附属医院)内分泌科,广东深圳518035

出　　处：《广东医学》2024年第10期1331-1336,共6页Guangdong Medical Journal

基　　金：深圳市科创委基础研究重点项目(JCYJ20220818102001003);深圳市医疗卫生“三名工程”项目(SZSM202211026)。

摘　　要：目的利拉鲁肽辅助治疗调控肥胖型初发2型糖尿病患者代谢紊乱的效果研究。方法前瞻性选择2022年4月至2023年4月收治的2型糖尿病初发型首诊患者,筛选条件为代谢紊乱所致的肥胖型患者,共筛选出116例,按用药方式的不同将患者分为二甲双胍-1组、二甲双胍-2组、恩格列净-1组以及恩格列净-2组。其中二甲双胍-1组与恩格列净-1组单独给药二甲双胍与恩格列净,而二甲双胍-2组与恩格列净-2在单独给药的基础上,均联合给药利拉鲁肽,治疗周期12周,观察4组患者治疗前(T0)及治疗3个疗程后(T1)的肥胖指标[体质指数(BMI)、腰围],糖代谢指标[空腹血糖(FPG)、餐后2h血糖(2hPG)、糖化血红蛋白(HbA1C)],脂代谢指标[高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TC)、三酰甘油(TG)],胰岛素抵抗指数(HOMA-IR),胰岛β细胞功能指数(HOMA-β),总脂联素(tAPN),鸢尾素(Irisin),血清分泌型卷曲相关蛋白5(SFRP5)等指标,并在治疗期间记录患者不良反应发生情况。结果4组患者T0时肥胖指标、糖代谢指标、脂代谢指标、HOMA-IR、HOMA-β、血清tAPN、血清Irisin、血清SFRP5相比较,差异无统计学意义(P>0.05);二甲双胍-1组与恩格列净-1组T1时肥胖指标、糖代谢指标、脂代谢指标、HOMA-IR、HOMA-β、血清tAPN、血清Irisin、血清SFRP5相比较,差异无统计学意义(P>0.05);4组患者T1时肥胖指标、糖代谢指标、脂代谢指标、HOMA-IR、HOMA-β、血清tAPN、血清Irisin、血清SFRP5相比较,二甲双胍-2组与恩格列净-2组较二甲双胍-1组与二甲双胍-1组改善更为显著(P<0.05);4组患者头痛头晕、消化道反应、尿感、低血糖等不良反应发生总概率差异无统计学意义(P>0.05)。结论对于初发型2型糖尿病伴肥胖患者的治疗,在疾病发生初期进行健康教育指导,并采用二甲双胍或恩格列净等药物治疗均有较好的效果,在加用利拉鲁肽辅助治疗�Objective To investigate the efficacy of liraglutide as an adjunct therapy in regulating metabolic disorders in obese patients with newly diagnosed type 2 diabetes.Methods This prospective study selected 116 patients diagnosed with newly onset type 2 diabetes and obesity due to metabolic disorders from April 2022 to April 2023.Patients were divided into four groups based on their medication regimen:Metformin-1 group,Metformin-2 group,Empagliflozin-1 group,and Empagliflozin-2 group.The Metformin-1 and Empagliflozin-1 groups received monotherapy with Metformin and Empagliflozin,respectively,while the Metformin-2 and Empagliflozin-2 groups received liraglutide in addition to their respective monotherapies over a 12-week treatment period.Changes in obesity indices[(body mass index(BMI),waist circumference],glucose metabolism indices[fasting plasma glucose(FPG),2-hour postprandial glucose(2hPG),glycated hemoglobin(HbA1C)],lipid metabolism indices[high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),total cholesterol(TC),triglycerides(TG)],insulin resistance index(HOMA-IR),pancreaticβ-cell function index(HOMA-β),total adiponectin(tAPN),irisin,and serum secreted frizzled-related protein 5(SFRP5)were observed.Adverse reactions were also recorded during treatment.Results At baseline(T0),there were no significant differences among the four groups regarding obesity indices,glucose metabolism indices,lipid metabolism indices,HOMA-IR,HOMA-β,tAPN,irisin,and SFRP5(P>0.05).Similarly,comparisons between Metformin-1 and Empagliflozin-1 groups at T1 showed no significant differences(P>0.05).However,the improvements in T1 for obesity,glucose,and lipid metabolism indices,HOMA-IR,HOMA-β,tAPN,irisin,and SFRP5 were significantly more pronounced in the Metformin-2 and Empagliflozin-2 groups compared to their respective monotherapy groups(P<0.05).The overall incidence of adverse reactions,including headache,dizziness,gastrointestinal reactions,urinary infections,and hypoglycemia,did not differ signifi

关 键 词：利拉鲁肽 2型糖尿病 代谢紊乱 肥胖 辅助治疗 

分 类 号：R587.1[医药卫生—内分泌] R453.9[医药卫生—内科学]