利拉鲁肽联合达格列净治疗超重及肥胖2 型糖尿病 患者的疗效及对胰岛功能的影响

Efficacy of liraglutide combined with dapagliflozin in the treatment of overweight and obese patients with type Ⅱ diabetes mellitus and its effects on pancreatic islet function

摘要:

目的 探究利拉鲁肽联合达格列净治疗超重和肥胖2 型糖尿病（T2DM）患者的疗效，以及对患 者胰岛功能的影响。方法 选取2018 年2 月—2019 年10 月在天津市第一中心医院初治的超重或肥胖T2DM 患者96 例，随机分为对照组与观察组，每组48 例。对照组用利拉鲁肽治疗，观察组在对照组基础上加用达 格列净。所有患者连续治疗12 周。记录患者治疗前后体质指数（BMI）、腰围、糖化血红蛋白（HbAlc）、空 腹血浆血糖（FPG）、餐后2 h 血糖（2 hPG）、舒张压（DBP）、收缩压（SBP）、甘油三酯（TG）、总胆固醇 （TC）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、空腹胰岛素（FINS）、餐后2 h 胰岛素（2 hINS）、稳态胰岛素评价指数（HOMA-IR）、稳态胰岛β 细胞分泌功能指数（HOMA-β）、胰 岛素敏感指数（ISI），以及治疗期间不良反应发生情况。结果 观察组治疗前后BMI、腰围、HbA1c、FPG 及2 hPG 的差值高于对照组（P <0.05）；观察组治疗前后DBP、SBP、TG、TC、HDL-C 及LDL-C 的差值 高于对照组（P <0.05）。观察组治疗前后FINS、2 hINS、HOMA-IR、HOMA-β 及ISI 的差值高于对照组 （P <0.05）。对照组与观察组治疗期间不良反应总发生率分别为27.08% 和29.17%，差异无统计学意义（P >0.05）。 结论 利拉鲁肽联合达格列净治疗超重和肥胖T2DM 患者，能够有效降低患者血糖和BMI，解除患者体内高 血糖毒性作用，调节糖脂代谢，保护胰岛功能且安全性好；对于降低超重和肥胖T2DM 患者的体重，提高疗 效有重要意义。

Abstract:

Objective To investigate the efficacy of liraglutide combined with dapagliflozin in the treatment of overweight and obese patients with type Ⅱ diabetes mellitus (T2DM) and its effects on pancreatic islet function of the patients. Methods A total of 96 overweight or obese T2DM patients who were treated in our hospital from February 2018 to October 2019 were selected, and the patients were randomly divided into the control group (n = 48) and the observation group (n = 48). The control group was treated with liraglutide, while the observation group was additionally treated with dapagliflozin on the basis of the control group. All patients were treated continuously for 12 weeks. Body mass index (BMI), waist circumference, glycated hemoglobin (HbAlc), fasting plasma glucose (FPG), 2h plasma glucose (2hPG), diastolic blood pressure (DBP), systolic blood pressure (SBP), triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), fasting insulin (FINS), 2-hour insulin (2 hINS), homeostasis model assessment of insulin resistance (HOMA-IR), homeostasis model assessment of β-cell function (HOMA-β), insulin sensitivity index (ISI) were recorded before and after treatment, and occurrence of adverse reactions during treatment were recorded. Results The alterations of BMI, waist circumference, HbA1c, FPG and 2hPG before and after treatment in the observation group were significantly greater than those in the control group (P < 0.05), and similar differences were seen in the alterations of DBP, SBP, TG, TC, HDL-C and LDL-C before and after treatment between the two groups (P < 0.05). The differences between the two groups in FINS, 2 hINS, HOMA-IR, HOMA-β and ISI before and after the treatment were statistically significant (P < 0.05) as well, with those of observation group being greater. Besides, there was no difference in incidence of adverse reactions between the two groups during the treatment (P > 0.05). Conclusions Liraglutide combined with dapagliflozin in the treatment of overweight and obese T2DM patients can effectively and safely reduce blood glucose and BMI of patients, relieve hyperglycemic toxicity in patients, regulate glycolipid metabolism, and protect pancreatic islet function, which is of great significance to reduce the weight and therefore to improve efficacy of the treatment for overweight and obesity T2DM patients.