胰岛素强化疗法序贯司美格鲁肽治疗肥胖中青年T2DM患者的临床疗效与安全性研究  

Clinical efficacy and safety of intensive insulin therapy followed by semaglutide in obese young and middle-aged patients with type 2 diabetes mellitus

作　　者：陈雪辉[1] 尹清风[1] 孟祥雨 耿锐娜 王旭 徐云 白立炜[1] CHEN Xue-hui;YIN Qing-feng;MENG Xiang-yu;GENG Rui-na;WANG Xu;XU Yun;BAI Li-wei(First Ward,Department of Endocrinology,the First Affiliated Hospital of Xinxiang Medical University,Xinxiang 453100,Henan,CHINA)

机构地区：[1]新乡医学院第一附属医院内分泌科一病区,河南新乡453100

出　　处：《海南医学》2025年第8期1098-1103,共6页Hainan Medical Journal

基　　金：河南省医学科技攻关计划联合共建项目(编号:LHGJ20190458)。

摘　　要：目的探讨胰岛素强化疗法序贯司美格鲁肽治疗肥胖中青年T2DM患者的临床疗效及安全性。方法前瞻性选取2021年8月至2024年2月新乡医学院第一附属医院收治的120例肥胖中青年T2DM患者纳入研究,按随机数表法分为观察组和对照组各60例。两组患者均予以胰岛素泵强化降糖,待高血糖状态解除后,对照组序贯二甲双胍治疗,观察组于对照组基础上序贯司美格鲁肽治疗,治疗3个月。比较两组患者治疗前后的空腹血糖(FBG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbA1c)、葡萄糖目标范围内时间(TIR)、体质量指数(BMI)、内脏脂肪指数(VAI)、胰岛β细胞功能[胰岛素抵抗指数(HOMA-IR)、空腹C肽、餐后1 h C肽、胰岛素敏感性检测指数(QUICKI)]、血脂[总胆固醇、甘油三酯、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)]、血清内酯素(Visfatin)、网膜素-1(omentin-1)、趋化素(Chemerin),同时比较两组患者治疗期间的不良反应发生情况。结果治疗后,观察组患者的FBG、2 hPG、HbA1c、BMI、VAI分别为(5.34±0.71)mmoL/L、(9.00±0.84)mmoL/L、(5.76±0.51)%、(24.26±0.35)kg/m2、3.15±0.71,明显低于对照组的(6.02±0.56)mmoL/L、(11.35±1.01)mmoL/L、(6.28±0.40)%、(26.00±0.49)kg/m2、3.54±0.64,TIR为(95.00±1.52)%,明显高于对照组的(88.46±3.71)%,差异均有统计学意义(P<0.05);治疗后,观察组患者的HOMA-IR为2.16±0.32,明显低于对照组的2.65±0.40,空腹C肽、餐后1 h C肽、QUICKI分别为(3.85±0.27)ng/mL、(7.64±0.43)ng/mL、0.52±0.13,明显高于对照组的(3.02±0.46)ng/mL、(6.02±0.38)ng/mL、0.41±0.10,差异均有统计学意义(P<0.05);治疗后,观察组患者的总胆固醇、甘油三酯、LDL-C、Vaspin、chemerin分别为(3.25±0.42)mmoL/L、(1.77±0.25)mmoL/L、(1.89±0.42)mmoL/L、(70.92±4.68)ng/L、(45.84±4.90)ng/L,明显低于对照组的(3.90±0.53)mmoL/L、(2.08±0.34)mmoL/L、(2.21±0.36)mmoL/L、(75.00±5.15)ng/L、(51.03±5.66)ng/L,HDL-C、oObjective To investigate the clinical efficacy and safety of intensive insulin therapy followed by semaglutide in obese young and middle-aged patients with type 2 diabetes mellitus(T2DM).Methods A prospective study was conducted on 120 obese young and middle-aged T2DM patients admitted to the First Affiliated Hospital of Xinxiang Medical University from August 2021 to February 2024.The patients were randomly divided into an observa-tion group and a control group,with 60 patients in each group.Both groups of patients received intensive insulin pump therapy for glycemic control.After the hyperglycemic state was resolved,patients in the control group received metfor-min treatment,while those in the observation group received semaglutide in addition to metformin for 3 months.The fol-lowing parameters were compared before and after treatment:fasting blood glucose(FBG),2-hour postprandial blood glucose(2 hPG),glycated hemoglobin(HbA1c),time in range(TIR),body mass index(BMI),visceral adiposity index(VAI),pancreaticβ-cell function(homeostasis model assessment of insulin resistance[HOMA-IR],fasting C-peptide,1-hour postprandial C-peptide,quantitative insulin sensitivity check index[QUICKI]),lipid profile(total cholesterol,tri-glycerides,high-density lipoprotein cholesterol[HDL-C],low-density lipoprotein cholesterol[LDL-C]),serum visfatin,omentin-1,and chemerin.Adverse reactions during treatment were also compared.Results After treatment,the FBG,2 hPG,HbA1c,BMI,and VAI of the observation group were(5.34±0.71)mmoL/L,(9.00±0.84)mmoL/L,(5.76±0.51)%,(24.26±0.35)kg/m²,and 3.15±0.71,respectively,which were significantly lower than(6.02±0.56)mmoL/L,(11.35±1.01)mmoL/L,(6.28±0.40)%,(26.00±0.49)kg/m²,and 3.54±0.64 of the control group;TIR was(95.00±1.52)%,which was significantly higher than(88.46±3.71)%of the control group;the differences were statistically significant(P<0.05).After treatment,the HOMA-IR of patients in the observation group was 2.16±0.32,which was significantly lower than 2.65±0.40 of the control g

关 键 词：肥胖 中青年 2型糖尿病 司美格鲁肽 血糖 胰岛Β细胞功能 不良反应 

分 类 号：R587.1[医药卫生—内分泌]