目的 观察探讨利拉鲁肽和艾塞那肽分别联合二甲双胍片治疗老年2型糖尿病(T2DM)的有效性及对微炎症反应、脂肪因子的影响.方法 选取2020年9月至2021年9月浙江省长兴县人民医院收治的T2DM患者98例,按治疗方法分为2组,每组49例,2组均给予盐酸二甲双胍片治疗,在此基础上A组联合利拉鲁肽治疗,B组联合艾塞那肽治疗,比较2组治疗前后基线资料[体质量、体质量指数(BMI)、腰臀比]、糖代谢[空腹血糖(FPG)、餐后2 h血糖(2 h PBG)、糖化血红蛋白(HbA1c)]、胰岛素抵抗[胰岛素抵抗指数(HOMA-IR)、胰岛β细胞功能指数(HOMA-β)]、脂代谢、微炎症反应[白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、急性时相血清淀粉样蛋白A(ASAA)、NOD样受体蛋白3(NLRP3)炎症小体]、脂肪因子[丝氨酸蛋白酶抑制剂(Vaspin)、脂联素(ADP)、游离脂肪酸(FFA)]、肝肾功能及不良反应发生情况.结果 治疗后,A组和 B 组体质量、BMI、腰臀比、FPG、2 h PBG、HbA1c、HOMA-IR 均较治疗前降低(t=2.189、3.557、3.280、6.505、5.629、6.730、4.965 与 t=2.008、2.055、2.186、3.185、2.213、5.262、2.519,P 均＜0.05),HOMA-β 均升高(t=5.495 与 t=2.577,P均＜0.05),且 A 组腰臀比、FPG、2 h PBG、HbA1c、HOMA-IR、HOMA-β 变化幅度大于 B 组(t=4.950、2.232、5.412、2.069、2.192、2.044,P均＜0.05);A 组体质量下降幅度、HbA1c 达标率高于 B 组(t=1.999、x2=4.640,P均＜0.05).治疗后,A 组和 B 组 IL-6、TNF-α、ASAA、NLRP3 水平均降低(t=7.612、5.201、4.059、3.264与t=7.504、4.980、3.935、2.516,P均＜0.05),但组间比较差异均无统计学意义(P＞0.05).治疗后,A组和B组Vaspin、ADP水平均升高(t=5.156、4.842与t=4.443、5.438,P均＜0.05),但A、B 2组间比较差异均无统计学意义(P＞0.05).治疗后,A组和B组白细胞计数(WBC)、血小板计数(PLT)、红细胞计数(RBC)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、血尿素氮(BUN)、肌酐(Cr)比较,差异均无统计学意义(P＞0.05).治疗期间,A组和B组低血糖事件发生率比较无统计学意义(P＞0.05);A组不良反应总发生率(8％)低于B组(24％)(x2=4.780,P＜0.05).结论 利拉鲁肽和艾塞那肽分别联合二甲双胍片治疗老年T2DM患者疗效确切,降糖作用显著,均可下调体内微炎症反应和脂肪因子水平,但利拉鲁肽血糖控制效果更佳,且安全性更高,值得临床推广.
Effectiveness of liraglutide or exenatide combined with metformin tablets in the treatment of elderly type 2 diabetes mellitus and influence on microinflammatory response and adipokines
Objective To explore the effectiveness of liraglutide or exenatide combined with metformin tablets in the treatment of elderly patients with type 2 diabetes mellitus(T2DM)and influence on microinflammatory response and adipokines.Methods A total of 98 T2DM patients admitted between September 2020 and September 2021 were selected and divided into Group A(odd number)and Group B(even number)depending on the treatment method,with 49 cases in each group.Both groups were treated with metformin hydrochloride tablets.On this basis,group A was treated with liraglutide and group B was treated with exenatide.The baseline data[body weight,body mass index(BMI),waist-to-hip ratio],glucose metabolism[fasting plasma glucose(FPG),postprandial 2h blood glucose(2 h PBG),glycosylated hemoglobin(HbA1c)],insulin resistance[homeostasis model assessment of insulin resistance(HOMA-IR),islet β-cell function index(HOMA-[3)],lipid metabolism,microinflammatory response[interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),acute phase serum amyloid A(ASAA),NOD-like receptor protein 3(NLRP3)inflammasome],adipokines[Vaspin,adiponectin(ADP),free fatty acid(FFA)],liver and kidney function and occurrence of adverse reactions were compared between the two groups before and after treatment.Results After treatment,the body weight,BMI,waist-to-hip ratio,FPG,2 h PBG,HbA1c,HOMA-IR of the both groups were significantly decreased[(t=2.189,3.557,3.280,6.505,5.629,6.730)vs(t=2.008,2.055,2.186,3.185,2.213,5.262,2.519),all P＜0.05],while the HOMA-β was significantly increased[(t=5.495)vs(t=2.577),P＜0.05].And the changes of waist-to-hip ratio,FPG,2hPBG,HbA1c,HOMA-IR and HOMA-β in group A were larger than those in group B(t=4.950,2.232,5.412,2.069,2.192,2.044,all P＜0.05).The weight loss and HbA1c compliance rate in group A were significantly higher than those in group B(t=1.999,x2=4.640,P＜0.05).After treatment,the levels of IL-6,TNF-α,ASAA and NLRP3 in group A and group B were declined significantly[(t=7.612,5.201,4.059.3.264)vs(t=7.504,4.980,3.935,2.516),all P＜0.05)],and the levels of Vaspin and ADP were risen significantly[(t=5.156,4.842)vs(t=4.443,5.438),all P＜0.05)],but there were no statistical differences between groups(P＞0.05).After treatment,there was no statistically significant difference in WBC,PLT,RBC,ALT,AST,BUN,and Cr between group A and group B(P＞0.05).During the treatment period,there was no statistically significant difference in the incidence rate of hypoglycemic events between two groups(P＞0.05);but the total incidence rate of adverse reactions in group A(8％)was significantly lower than that in group B(24％)(x2=4.780,P＜0.05).Conclusion The combination of liraglutide and exenatide with metformin tablets has a definite therapeutic effect on elderly T2DM patients,with significant hypoglycemic effects.Both liraglutide and exenatide can downregulate microinflammatory response and adipokine levels.However,liraglutide has better blood glucose control effect and higher safety,which is worthy of clinical promotion.
万方数据
维普
