度拉糖肽与司美格鲁肽治疗肥胖型T2DM的疗效对比及对脂质蓄积指数、血管内皮功能的影响

Comparison of the efficacy of dulaglutide and semaglutide in the treatment of obese type 2 diabetes mellitus and their effects on lipid accumulation product and vascular endothelial function

摘要:

目的 分析度拉糖肽与司美格鲁肽强化治疗肥胖型2型糖尿病（T2DM）的疗效及对脂质蓄积指数（LAP）、血管内皮功能的影响。方法 回顾性分析2022年6月—2025年4月邯郸市第一医院收治的86例肥胖型T2DM患者的临床资料，按治疗方法分为两组，对照组44例采用度拉糖肽治疗，观察组42例采用司美格鲁肽治疗，均治疗12周。比较两组治疗效果、脂质蓄积指数（LAP）、胰岛素敏感性［稳态模型胰岛素抵抗指数（HOMA-IR）、稳态模型胰岛β细胞功能指数（HOMA-β）］、血管内皮功能［内皮素-1（ET-1），一氧化氮（NO），血栓素A₂（TXA₂）］、肥胖指数［体质量指数（BMI）、腰臀比（WHR）］、糖脂代谢指标［空腹血糖（FPG）、餐后 2 h血糖（2hPG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、总胆固醇（TC）、甘油三酯（TG）］，以及不良反应。结果 观察组总有效率高于对照组（P <0.05）。观察组治疗后LAP、HOMA-IR均低于对照组，HOMA-β高于对照组（P <0.05）。观察组治疗后ET-1、TXA₂均低于对照组，NO高于对照组（P <0.05）。观察组治疗后BMI、WHR均低于对照组（P <0.05）。观察组治疗后FPG、2hPG、TC、LDL-C、TG均低于对照组（P <0.05），HDL-C高于对照组（P <0.05）。观察组与对照组不良反应总发生率比较，差异无统计学意义（P >0.05）。结论 相较于度拉糖肽治疗，司美格鲁肽在改善肥胖型T2DM患者血管内皮功能、LAP水平、胰岛素敏感性、糖脂代谢、肥胖指数方面具有显著效果。

Abstract:

Objective To compare the efficacy of dulaglutide and semaglutide in the intensive treatment of obese patients with type 2 diabetes mellitus (T2DM) and their effects on lipid accumulation product (LAP) and vascular endothelial function.Methods Clinical data of 86 obese T2DM patients admitted to Handan First Hospital from June 2022 to April 2025 were retrospectively analyzed. According to the treatment methods, they were divided into two groups: the control group (n = 44) received dulaglutide, and the observation group (n = 42) received semaglutide, both for 12 weeks. The therapeutic efficacy, lipid accumulation product (LAP), insulin sensitivity [homeostasis model assessment of insulin resistance (HOMA-IR), homeostasis model assessment of β-cell function (HOMA-β) ], vascular endothelial function [endothelin-1 (ET-1), nitric oxide (NO), thromboxane A₂ (TXA₂) ], obesity indices [body mass index (BMI), waist-to-hip ratio (WHR) ], glycolipid metabolism parameters [fasting plasma glucose (FPG), 2-hour postprandial plasma glucose (2hPG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC), triglyceride (TG) ], and adverse reactions were compared between the two groups.Results The total effective rate in the observation group was higher than that in the control group (P < 0.05). After treatment, the observation group showed significantly lower? levels of LAP and HOMA-IR, but a significantly higher? level of HOMA-β compared to the control group (P < 0.05). After treatment, the observation group exhibited significantly lower? levels of ET-1 and TXA₂, but a significantly higher? level of NO compared to the control group (P < 0.05). After treatment, the observation group had significantly lower? BMI and WHR values than the control group (P < 0.05). After treatment, the levels of FPG, 2hPG, TC, LDL-C, and TG in the observation group were lower than those in the control group (P < 0.05), while the HDL-C level was higher (P < 0.05). There was no statistically significant difference in the total incidence of adverse reactions between the observation group and the control group (P > 0.05).Conclusion Compared with dulaglutide, semaglutide shows superior effects in improving vascular endothelial function, LAP, insulin sensitivity, glycolipid metabolism, and obesity indices in obese patients with T2DM.