目的:观察采用司美格鲁肽联合达格列净治疗二甲双胍治疗不佳的 2 型糖尿病(T2DM)患者的临床效果,并分析其对糖脂代谢、胰岛功能及血管内皮功能的影响.方法:选取从 2021 年 6 月—2023 年 2月在新余市人民医院内分泌科诊治的120例单用二甲双胍治疗不佳的T2DM患者作为研究对象,随机分为两组,分别为单一用药组(n=60)和联合用药组(n=60).单一用药组给予达格列净治疗,联合用药组在单一用药组治疗基础上给予司美格鲁肽治疗,两组均治疗 12 周.比较两组血糖指标[空腹血糖(FPG)、餐后 2 h血糖(2 h PBG)和糖化血红蛋白(HbA1c)水平];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)];胰岛功能指标[空腹胰岛素(FINS)水平、胰岛素β细胞功能指数(HOMA-β)和胰岛素抵抗指数(HOMA-IR)];血管内皮功能指标[血管内皮生长因子(VEGF)、人C1q/TNF相关蛋白 9(CTRP9)、氧化型低密度脂蛋白(OX-LDL)、一氧化氮(NO)和血清内皮素(ET-1)];生化指标[同型半胱氨酸(Hcy)、白蛋白/肌酐(ACR)和胱抑素C(Cys-C)水平]和不良反应发生情况(恶心呕吐、尿路感染、低血糖、皮疹).结果:治疗后,联合用药组的血糖各指标(FPG、2 h PBG和HbA1c)均低于单一用药组(P<0.05);联合用药组的TG、TC和LDL-C水平均低于单一用药组,而HDL-C水平高于单一用药组(P<0.05);联合用药组的FINS和HOMA-IR均低于单一用药组,而HOMA-β高于单一用药组(P<0.05);联合用药组的VEGF、OX-LDL和ET-1 均低于单一用药组,而CTRP9 和NO均高于单一用药组(P<0.05);联合用药组的Hcy、ACR和Cys-C水平均低于单一用药组,差异均有统计学意义(P<0.05).两组不良反应发生率比较,差异无统计学意义(P>0.05).结论:二甲双胍治疗不佳的T2DM患者应用司美格鲁肽联合达格列净疗效显著,有较好的安全性,对血糖、血脂、胰岛和血管内皮功能明显改善,减轻机体微炎症状态.
The Impact of the Combination of Semaglutide and Dapagliflozin on Type 2 Diabetes Mellitus Patients with Poor Response to Metformin Therapy
Objective:To observe the clinical efficacy of using Semaglutide combined with Dapagliflozin in the treatment of type 2 diabetes mellitus(T2DM)patients with poor response to Metformin,and to analyze its effects on glycemic and lipid metabolism,pancreatic function,and vascular endothelial function.Method:A total of 120 T2DM patients with poor response to Metformin who were treated in the Endocrinology Department of Xinyu People's Hospital from June 2021 to February 2023 were selected as the research subjects,they were randomly divided into two groups,with 60 patients in the single medication group and 60 patients in the combination medication group.The single medication group was treated with Dapagliflozin,and the combination medication group received Semaglutide on the basis of single medication group,both groups were treated for 12 weeks.The glycemic indicators[fasting plasma glucose(FPG),2 hour postprandial blood glucose(2 h PBG),and glycated hemoglobin(HbA1c)levels],lipid indicators[triglycerides(TG),total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C)and high-density lipoprotein cholesterol(HDL-C)],pancreatic function indicators[fasting insulin(FINS)levels,homeostasis model assessment of beta-cell(HOMA-β)and homeostasis model assessment of insulin resistance(HOMA-IR)],vascular endothelial function indicators[vascular endothelial growth factor(VEGF),human C1q/TNF-related protein 9(CTRP9),oxidized low-density lipoprotein(OX-LDL),nitric oxide(NO),and serum endothelin-1(ET-1)],biochemical indicators[homocysteine(Hcy),albumin/creatinine(ACR)and cystatin C(Cys-C)levels],and occurrence of adverse reactions(nausea/vomiting,urinary tract infection,hypoglycemia,rash)were compared between the two groups.Result:After treatment,levels of blood glucose indicators(FPG,2 h PBG and HbA1c)in the combination medication group were lower compared to those in the single medication group(P<0.05);levels of TG,TC,and LDL-C in the combination medication group were lower,and level of HDL-C was higher compared to the single medication group(P<0.05);levels of FINS and HOMA-IR in the combination medication group were lower,and level of HOMA-β was higher compared to the single medication group(P<0.05);levels of VEGF,OX-LDL,and ET-1 in the combination medication group were lower,and levels of CTRP9 and NO were higher compared to those in the single medication group(P<0.05);levels of Hcy,ACR,and Cys-C in the combination medication group were lower,the differences were statistically significant(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups after treatment(P>0.05).Conclusion:Semaglutide combined with Dapagliflozin has significant clinical efficacy and good safety in the treatment of T2DM patients with poor response to Metformin,and it significantly improves glycemic control,lipid profile,pancreatic function,and vascular endothelial function,as well as reduces systemic low-grade inflammation.
万方数据
维普
