利拉鲁肽联合短期胰岛素强化治疗2型糖尿病伴肥胖患者对空腹血糖、胰岛素抵抗指数及炎性反应指标的影响

目的探讨利拉鲁肽联合短期胰岛素强化治疗2型糖尿病伴肥胖患者对空腹血糖、胰岛素抵抗指数(HOMA-IR)及炎性反应指标的影响。方法选取2017年2月至2019年3月太原中西医结合医院内科收治的198例初诊为2型糖尿病伴肥胖的患者,男106例,女92例,年龄(53.49±7.09)岁,年龄范围为36~69岁。采用随机数表法将患者随机分为单纯治疗组与联合治疗组,每组99例。单纯治疗组患者给予短期胰岛素强化治疗,联合治疗组患者给予利拉鲁肽联合短期胰岛素强化治疗,比较两组患者治疗前后的血糖相关指标空腹血糖、糖化血红蛋白(HbA1c)、餐后2 h血糖(2 hPBG)]、胰岛素分泌指数(HOMA-β)、HOMA-IR、炎性反应指标脂联素、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]及血脂相关指标水平甘油三酯、总胆固醇、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)]的变化。结果结论治疗后,联合治疗组患者的空腹血糖(6.87±0.72)mmol/L]、HbA1c(7.06±0.82)%]、2 hPBG(7.59±0.85)mmol/L]水平均低于单纯治疗组(7.37±0.81)mmol/L、(7.69±0.74)%、(8.95±0.93)mmol/L];HOMA-β(85.32±18.62)]高于单纯治疗组(63.19±12.37)],HOMA-IR(2.97±0.22)]低于单纯治疗组(4.32±0.37)];脂联素水平(1.76±0.16)μg/L]高于单纯治疗组(1.38±0.14)μg/L],IL-6(9.34±0.95)ng/L]、TNF-α水平(29.89±4.32)ng/L]低于单纯治疗组(12.27±1.33)ng/L、(37.18±4.87)ng/L];甘油三酯(0.68±0.09)mmol/L]、总胆固醇(4.48±0.79)mmol/L]、LDL-C(2.35±0.16)mmol/L]水平低于单纯治疗组(1.44±0.17)mmol/L、(6.08±0.76)mmol/L、(3.06±0.15)mmol/L],HDL-C水平(1.72±0.14)mmol/L]高于单纯治疗组(1.32±0.12)mmol/L],差异均有统计学意义(P<0.05)。两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论利拉鲁肽联合短期胰岛素强化治疗2型糖尿病伴肥胖患者能够有效控制血糖,减轻患者胰岛素抵抗及炎性反应指标,值得在临床上推广应用。

Effects of liraglutide combined with short-term intensive insulin therapy on fasting glucose,insulin resistance index and inflammatory response index in patients with type 2 diabetes mellitus and obesity

Objective To investigate the effects of liraglutide combined with short-term intensive insulin therapy on fasting glucose,insulin resistance index(HOMA-IR)and inflammatory response indexes in patients with type 2 diabetes mellitus and obesity.Methods A retrospective study was performed on 198 cases of patients with type 2 diabetes mellitus combined with obesity who were admitted from February 2017 to March 2019.There were 106 male and 92 female,aged(53.49±7.09)years old,ranging from 36 to 69 years old.Patients were randomly divided into the single treatment group and the combination group,with 99 cases in each group.Single treatment group of patients were given short-term insulin intensive therapy,the combined treatment group of patients were given the liraglutide combined with short-term insulin intensive treatment.Two groups of patients were compared before and after treatment of blood glucose related indexfasting blood glucose,glycosylated hemoglobin(HbA1c),2 hours postprandial blood glucose(2 hPBG)],homeostasis model assessment-β(HOMA-β),HOMA-IR,inflammatory response indextriglyceride,total cholesterol,low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C)].Results After treatment,FBG(6.87±0.72)mmol/L],HbAlc(7.06±0.82)%],and 2hPBG(7.59±0.85)mmol/L]were lower in the combination group than in the single treatment group(7.37±0.81)mmol/L,(7.69±0.74)%,and(8.95±0.93)mmol/L].HOMA-β(85.32±18.62)in the combination group was higher than(63.19±12.37)in the single treatment group,HOMA-IR(2.97±0.22)in the combination group was lower than(4.32±0.37)of the single treatment group.Adiponectin levels(1.76±0.16)μg/L]in the combination group were higher than(1.38±0.14)μg/L]in the single treatment group.IL-6(9.34±0.95)ng/L]and TNF-α level(29.89±4.32)ng/L]in the combination group were lower than(12.27±1.33)ng/L] and(37.18±4.87)ng/L]in the single treatment group.The levels of triglycerides(0.68±0.09)mmol/L],total cholesterol(4.48±0.79)mmol/L],LDL-C(2.35±0.16)mmol/L]in the combination group were lower than(1.44±0.17)mmol/L],(6.08±0.76)mmol/L],(3.06±0.15)mmol/L]in the single treatment group,and HDL-C(1.72±0.14)mmol/L]in the combination group was higher than(1.32±0.12)mmol/L]in the single treatment group,and the differences were statistically significant(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Liraglutide combined with short-term insulin intensive treatment of type 2 diabetes mellitus with obesity can effectively control blood glucose,reduce insulin resistance and inflammatory response,which is worthy of clinical promotion.