利拉鲁肽联合强化降糖序贯方案对初诊2型糖尿病患者血糖控制效果及胰岛素第一时相分泌的影响

目的研究利拉鲁肽联合强化降糖序贯方案对初诊2型糖尿病患者血糖控制效果及胰岛素第一时相分泌的影响。方法前瞻性选择2017年1月至2018年9月上海市杨浦区中心医院收治的68例T2DM患者,采用随机数字表法将患者分为对照组(n=34)和观察组(n=34)。完成胰岛素强化治疗后,对照组患者给予二甲双胍治疗,观察组患者在对照组的基础上加用利拉鲁肽治疗。比较两组患者的血糖指标、胰岛功能、胰岛素第一时相分泌情况、血清炎症因子水平和血管内皮功能。结果治疗前,两组患者的血糖指标相近,差异无统计学意义(P> 0. 05);治疗后,观察组患者的空腹血糖(FPG)、餐后2 h血糖(2 h PG)和糖化血红蛋白(HbAlc)水平分别为(6. 42±0. 85) mmol/L、(8. 27±1. 15) mmol/L和(5. 82±0. 95)%,低于对照组,空腹C肽(FCP)水平为(779. 62±73. 17) pmol/L,高于对照组,差异均具有统计学意义(P <0. 05)。治疗前,两组患者的胰岛功能指标相近,差异无统计学意义(P> 0. 05);治疗后,观察组的胰岛β细胞功能指数(HOMA-β)水平为(43. 64±9. 63)%,高于对照组,胰岛素抵抗指数(HOMA-IR)水平为(1. 48±0. 94),低于对照组,差异均具有统计学意义(P <0. 05)。治疗前,两组患者的AUCIns和AUCC-P相近,差异无统计学意义(P>0. 05);治疗后,观察组的AUCIns和AUCC-P水平分别为(758. 49±55. 28) mU·min/L和(37. 21±6. 29) ng·min/m L,高于对照组,差异均具有统计学意义(P <0. 05)。治疗前,两组患者的血清炎症因子水平和血管内皮功能相近,差异无统计学意义(P>0. 05);治疗后,观察组患者的白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)和内皮素-1(ET-1)水平分别为(10. 86±2. 91) ng/L、(6. 25±2. 34) ng/L和(51. 26±5. 29) ng/L,低于对照组,一氧化氮(NO)水平为(42. 37±5. 42)μmol/L,高于对照组,差异均具有统计学意义(P <0. 05)。结论与单纯强化降糖序贯方案相比,利拉鲁肽联合强化降糖序贯方案可以明显改善初诊T2DM患者的血管内皮功能和胰岛素第一时相分泌,改善糖代谢和胰岛功能,减轻患者的炎症状态。

Effect of liraglutide combined with intensive sequential hypoglycemic regimen on blood glucose control and insulin first phase secretion in newly diagnosed type 2 diabetes mellitus

Objective To study the effect of liraglutide combined with intensive hypoglycemic sequential regimen on blood glucose control and first-phase insulin secretion in newly diagnosed type 2 diabetes mellitus( T2 DM). Methods This is a prospective study,68 patients of T2 DM treated in Yangpu District Central Hospital from January 2017 to September 2018 were divided into control group( n = 34) and observation group( n = 34) using random number table method. After intensive insulin therapy,patients in the control group were treated with Metformin,while patients in the observation group were treated with Liraglutide on the basis of the control group. The blood sugar index,islet function,first-phase insulin secretion,serum inflammatory factor level and vascular endothelial function were compared between the two groups. Results Before treatment,the blood glucose indexes of the two groups were similar,and the difference was not statistically significant( P > 0. 05). After treatment,the fasting blood glucose( FPG),2 h plasma glucose( 2 h PG) and glycosylated hemoglobi( HbAlc) levels of the observation group were( 6. 42 ± 0. 85) mmol/L,( 8. 27 ± 1. 15) mmol/L and( 5. 82 ± 0. 95) %,lower than the control group,and the fasting C peptide( FCP)levels were( 779. 62 ± 73. 17) pmol/L,higher than the control group,with statistically significant differences( P < 0. 05). Before treatment,the islet function indexes of the two groups were similar,and the difference was not statistically significant( P > 0. 05). After treatment,the islet beta cell function index( HOMA-β) level of the observation group was( 43. 64 ± 9. 63) %,higher than that of the control group,and the insulin resistance index( HOMA-IR) level was( 1. 48 ± 0. 94),lower than that of the control group,with statistically significant differences( P< 0. 05). Before treatment,the AUCIns and AUCC-P of the two groups were similar,and the difference was not statistically significant( P >0. 05). After treatment,the AUCIns and AUCC-P levels in the observation group were( 758. 49 ± 55. 28) m U·min/L and( 37. 21 ± 6. 29) ng·min/m L,higher than those in the control group,and the differences were statistically significant( P <0. 05). Before treatment,serum levels of inflammatory cytokines and vascular endothelial function were similar between the two groups,with no statistically significant difference( P >0. 05). After treatment,interleukin-6( IL-6),tumor necrosis factor-α( TNF-α) and endothelin-1( ET-1) levels in the observation group were( 10. 86 ± 2. 91) ng/L,( 6. 25 ± 2. 34) ng/L and( 51. 26 ± 5. 29) ng/L,lower than those in the control group,and nitric oxide( NO) levels was( 42. 37 ±5. 42) ng/L,higher than the control group,with statistically significant differences( P <0. 05). Conclusion Compared with the simple intensive hypoglycemic sequential regimen,the application of liraglutide combined with intensive hypoglycemic sequential regimen can significantly improve vascular endothelial function and first-phase insulin secretion in newly diagnosed patients with T2 DM,improve glucose metabolism and islet function,and alleviate inflammation of patients.