目的 分析 2 型糖尿病合并肥胖患者采用二甲双胍联合恩格列净治疗对其血脂代谢的影响。方法 选择 120 例 2 型糖尿病合并肥胖病患，通过信封抽签分组方法分为对照组和研究组，每组60 例。对照组仅应用二甲双胍治疗，研究组采用二甲双胍联合恩格列净治疗。比较两组治疗效果及治疗前后的血糖指标[餐后 2 h血糖(2 h PBG)、空腹血糖(FPG)以及糖化血红蛋白(HbA1c)]、胰岛功能指标[胰岛β细胞功能指数(HOMA-β)、胰岛素抵抗指数(HOMA-IR)]、血脂指标[甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)和高密度脂蛋白胆固醇(HDL-C)]、炎性因子[白细胞介素-6(IL-6)、C反应蛋白(CRP)和肿瘤坏死因子-α(TNF-α)]、体质量指数(BMI)、体质量。结果 治疗后，研究组和对照组的 2 h PBG、FPG以及HbA1c水平均下降，治疗前后组内有明显差异(P<0。05);研究组治疗后的 2 h PBG(7。84±1。52)mmol/L、FPG(5。82±0。88)mmol/L以及HbA1c(6。72±0。87)%均低于对照组的(10。82±2。17)mmol/L、(6。94±0。75)mmol/L、(7。85±0。93)%，组间有明显差异(P<0。05)。治疗后，研究组和对照组的HOMA-β以及HOMA-IR水平均改善，治疗前后组内有明显差异(P<0。05);研究组治疗后的HOMA-β高于对照组，HOMA-IR低于对照组，组间有明显差异(P<0。05)。治疗后，研究组和对照组的TG、TC、LDL-C以及HDL-C水平均有改善，治疗前后组内有明显差异(P<0。05);研究组治疗后的TG、TC、LDL-C以及HDL-C水平分别为(1。87±0。32)、(4。15±0。32)、(2。35±0。64)、(1。54±0。53)mmol/L，优于对照组的(2。68±0。47)、(5。12±0。35)、(3。03±0。45)、(1。24±0。31)mmol/L，组间有明显差异(P<0。05)。治疗后，研究组和对照组的BMI和体质量均有下降，治疗前后组内有明显差异(P<0。05);研究组治疗后的BMI和体质量低于对照组，组间有明显差异(P<0。05)。治疗后，研究组和对照组的IL-6、CRP和TNF-α水平均有下降，治疗前后组内有明显差异(P<0。05);研究组治疗后的IL-6、CRP和TNF-α水平均低于对照组，组间有明显差异(P<0。05)。研究组治疗总有效率 96。67%高于对照组的83。33%，组间有明显差异(P<0。05)。结论 2 型糖尿病合并肥胖患者采用二甲双胍联合恩格列净治疗可显著提高血糖控制效果，还能有效帮助患者改善炎性反应、脂代谢以及胰岛素功能。
Effect of metformin combined with empagliflozin on blood lipid metabolism in type 2 diabetes patients with obesity
Objective To analyze effect of metformin combined with empagliflozin on blood lipid metabolism in type 2 diabetes patients with obesity.Methods 120 type 2 diabetes patients with obesity were selected and divided into a control group and a study group by envelope lottery grouping method,with 60 cases in each group.The control group was treated with metformin only,and the study group was treated with metformin combined with empagliflozin.Both groups were compared in terms of therapeutic effect,indicators of blood glucose[2 h postprandial blood glucose(2 h PBG),fasting plasma glucose(FPG),and glycosylated hemoglobin(HbA1c)],indicators of islet function[homeostasis model assessment of insulin resistance(HOMA-IR)and beta cell function(HOMA-β)],and lipid indices[triglyceride(TG),total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C)and high-density lipoprotein cholesterol(HDL-C)],inflammatory factors[interleukin-6(IL-6),C-reactive protein(CRP),and tumor necrosis factor-alpha(TNF-α)],body mass index(BMI),and body mass.Results After treatment,the levels of 2 h PBG,FPG and HbA1c in both the study group and the control group decreased,and there were significant differences before and after treatment(P<0.05).After treatment,the study group had 2 h PBG of(7.84±1.52)mmol/L,FPG of(5.82±0.88)mmol/L and HbA1c of(6.72±0.87)%,which were lower than(10.82±2.17)mmol/L,(6.94±0.75)mmol/L and(7.85±0.93)%in the control group.There were significant differences between groups(P<0.05).After treatment,the levels of HOMA-β and HOMA-IR were improved in both study group and control group,and there were significant differences before and after treatment(P<0.05).After treatment,the HOMA-β of the study group was higher than that of the control group,and the HOMA-IR was lower than that of the control group.There was significant difference between groups(P<0.05).After treatment,the levels of TG,TC,LDL-C and HDL-C in both study group and control group were improved,and there were significant differences before and after treatment(P<0.05).After treatment,the levels of TG,TC,LDL-C and HDL-C were(1.87±0.32),(4.15±0.32),(2.35±0.64)and(1.54±0.53)mmol/L in the study group,which were better than(2.68±0.47),(5.12±0.35),(3.03±0.45)and(1.24±0.31)mmol/L in the control group,and there were significant differences between groups(P<0.05).After treatment,BMI and body mass were decreased in both study group and control group,and there were significant differences before and after treatment(P<0.05).After treatment,the BMI and body mass of the study group were lower than those of the control group,and there were significant differences between groups(P<0.05).After treatment,the levels of IL-6,CRP and TNF-α were decreased in both study group and control group,and there were significant differences before and after treatment(P<0.05).After treatment,the levels of IL-6,CRP and TNF-α in the study group were lower than those in the control group,and there were significant differences between the groups(P<0.05).The total effective rate of the study group was 96.67%,which was higher than 83.33%of the control group(P<0.05).Conclusion The combination of metformin and empagliflozin in the treatment of type 2 diabetes patients with obesity can significantly improve the effect of blood glucose control,and effectively help patients improve inflammatory response,lipid metabolism and insulin function.
Type 2 diabetesObesityMetforminEmpagliflozinBlood lipid metabolismInflammatory factor
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