目的 研究司美格鲁肽(smegglutide)联合吡格列酮二甲双胍(pioglitazone hydrochloride/metformin hydro-chloride，PH/MH)对2型糖尿病(T2DM)合并代谢综合征(MS)疗效分析。方法 2021年10月—2023年10月80例许昌市中心医院收治的T2DM合并MS患者随机分为联合用药组(n=40)、对照组(n=40)，对照组患者给予PH/MH治疗，联合用药组患者在对照组基础上加用Smegglutide治疗。治疗前及治疗3个月后，检测血糖水平[空腹血糖(FBG)、餐后2 h血糖(2 h PBG)、糖化血红蛋白(HbA1c)]、体质量(BMI)、腰臀比(WHR)、胰岛素功能[胰岛β细胞功能指数(HOMA-β)、胰岛素抵抗(IR)指数(HOMA-IR)]、血脂[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)]、脂肪细胞因子水平[血浆脂联素(APN)、瘦素(LP)]、凝血因子[纤溶酶激活抑制物(PAI-1)、可溶性血管细胞黏附分子1(sVCAM-1)、组织型纤溶酶原激活物活性(t-PA)]、内分泌相关蛋白[β抑制蛋白2(β-arrestin2)、Toll样受体4(TLR4)、葡萄糖转运蛋白4(GLUT4)]水平并进行比较;治疗3个月期间，统计不良反应发生情况并进行比较。结果 治疗后，两组患者 FBG、2 h PBG、HbA1c、BMI、WHR、HOMA-IR、TG、TC、LDL-C、LP、PAI-1 低于治疗前;联合用药组治疗后的上述指标均显著低于对照组(P＜0。05)。治疗后，两组患者HOMA-β、HDL-C、APN、β-arrestin2高于治疗前;联合用药组治疗后的上述指标均显著高于对照组(P＜0。05)。治疗期间，联合用药组不良反应发生率与对照组无显著差异(P＞0。05)。结论 Smegglutide联合PH/MH对T2DM合并MS的治疗疗效显著，调理糖脂代谢，消除肥胖，有助于调节β-arrestin2、PAI-1水平以抑制IR、改善胰岛素功能。
Efficacy of Semaglutide combined with Pioglitazone hydrochloride/metformin hydrochloride in treating type 2 diabetes mellitus with metabolic syndrome
Objective To study the efficacy of semaglutide combined with pioglitazone hydrochloride/metformin hydro-chloride(PH/MH)in the treatment of type 2 diabetes mellitus(T2DM)with metabolic syndrome(MS).Methods Totally 80 patients with T2DM and MS from October 2021 to October 2023 were randomly divided into com-bined group(n=40)and control group(n=40).The control group was treated with PH/MH,and the combined group was given semaglutide on the basis of the control group.Blood glucose[fasting blood glucose(FBG),2-hour post-prandial blood glucose(2 h PBG),glycosylated hemoglobin(HbA1c)],body mass index(BMI),waist-to-hip ratio(WHR),insulin function[homeostasis model assessment of β cell function(HOMA-β),homeostasis model as-sessment ofinsulin resistance(IR)(HOMA-IR)],blood lipids[triglyceride(TG),total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C)],adipocytokines[plasma adiponectin(APN),leptin(LP)],coagulation factors[plasminogen activator inhibitor-1(PAI-1),soluble vascu-lar cell adhesion molecule-1(sVCAM-1),tissue plasminogen activator activity(t-PA)]and endocrine-related proteins[β-arrestin2,Toll-like receptor 4(TLR4),glucose transporter 4(GLUT)]were detected before treatment and after 3 months of treatment.The occurrence of adverse reactions was counted and comparedduring 3 months of treat-ment.Results After treatment,the FBG,2 h PBG,HbA1c,BMI,WHR,HOMA-IR,TG,TC,LDL-C,LP and PAI-1 in the two groups were lower than those before treatment,and the above indicators in combined group after treat-mentwere significantly lower than those in control group(P＜0.05).The HOMA-β,HDL-C,APN and β-arrestin2 in both groupsafter treatment were higher compared with those before treatment,and the above indicators after treatment-were significantly higher in combined group(P＜0.05).During the treatment,there was no significant difference in the incidence of adverse reactions between combined group and control group(P＞0.05).Conclusion Semaglutide com-bined with PH/MH has a significant efficacy in the treatment of T2DM with MS.It can regulate glucolipid metabolism,eliminate obesity,and help to regulate the levels of β-arrestin2 and PAI-1 to inhibit IR and improve insulin function.
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