目的 探究不同长效胰高血糖素样肽-1(GLP-1)受体激动剂药物在口服药物控制不佳2型糖尿病(T2DM)中的应用。方法 采用随机数字表法将120例口服药物控糖不佳的T2DM患者分为利拉鲁肽组、艾塞那肽组及胰岛素组，每组40例，3组分别给予利拉鲁肽、艾塞那肽及甘精胰岛素治疗。测定代谢指标、血清脂联素、瘦素、炎症因子水平，评价安全性。结果 治疗后利拉鲁肽组及艾塞那肽组体质量指数(BMI)、体脂率(FAT)、空腹血糖(FPG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(HbA1c)、胰岛素抵抗指数(HOMA-IR)、三酰甘油(TG)、低密度脂蛋白(LDL-C)低于胰岛素组(P＜0。05)，空腹胰岛素(FINS)水平高于胰岛素组(P＜0。05);利拉鲁肽组FPG、2 h PG低于艾塞那肽组(P＜0。05);艾塞那肽组LDL-C水平低于利拉鲁肽组(P＜0。05);治疗后利拉鲁肽组及艾塞那肽组脂联素水平高于胰岛素组(P＜0。05)，瘦素、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)低于胰岛素组(P＜0。05);与胰岛素组比较，利拉鲁肽及艾塞那肽总胃肠道不良反应发生率升高(P＜0。05)。结论 与甘精胰岛素比较，GLP-1受体激动剂用于口服药物血糖控制不佳T2DM患者中血糖控制效果更好，但胃肠道反应较多;其中利拉鲁肽对控制空腹及餐后血糖效果更好，艾塞那肽对血脂调节作用好且用药频率低。
Effects of different long-acting glucagon-like peptide-1 receptor agonists on HbA1c,FPG and BMI in pa-tients with type 2 diabetes mellitus who have poor glycemic control by oral medication
Objective To investigate the application of different long-acting glucagon-like peptide-1(GLP-1)receptor agonists in type 2 diabetes mellitus(T2DM)patients with Inadequate glycemic control by oral medications.Methods One hundred and twenty patients with T2DM with poor glycemic control by oral medication were divided into liraglutide group,exenatide group and insulin group by random number table method,with 40 patients in each group.The three groups were respectively treated with high-dose liraglutide,exenatide sustained release and insulin glargine.Metabolic indicators before and after treatment,levels of serum adiponectin,leptin and inflammatory factors were determined to evaluate safety.Results After treatment,the body mass index(BMI),body fat percentage(FAT),fasting plasma glucose(FPG),postprandial 2 h plasma glucose(2h PG),glycosylated hemoglobin(HbA1c),insulin resistance index(HOMA-IR),triglyceride(TG),and low-density lipoprotein(LDL-C)of the liraglutide group and exenatide group were significantly lower than those in the insulin group(P＜0.05),while fasting insulin(FINS)level was higher than that of the insulin group(P＜0.05).FPG and 2 h PG in the liraglutide group were lower than those in the exenatide group(P＜0.05).The LDL-C level of the exenatide group was lower than that of the liraglutide group(P＜0.05).After treatment,the adiponectin level of the liraglutide group and the exenatide group was significantly higher than that in the insulin group(P＜0.05),while the levels of leptin,interleukin-6(IL-6),and tumor necrosis factor-α(TNF-α)were lower than those in the insulin group(P＜0.05).Compared with the insulin group,the incidence of total gastrointestinal adverse reactions in the liraglutide and exenatide groups increased(P＜0.05).Conclusion Compared with insulin glargine,GLP-1 receptor agonist have better glycemic control effects in patients with with poor glycemic control by oral medication,but have more gastrointestinal reactions.Among them,liraglutide has a better effect on controlling fasting and postprandial blood glucose,while exenatide has a good effect on regulating blood lipids and a low frequency of medication use.
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