利拉鲁肽对超重或肥胖的2型糖尿病的疗效分析

目的：观察胰高血糖素样肽-1（GLP-1）类似物利拉鲁肽对超重或肥胖的2型糖尿病的疗效和安全性。方法：2012年8月～2014年8月在我院内分泌科住院和门诊治疗的2型糖尿病患者68例，以 BMI ≥24Kg/m2为超重，≥28 Kg/m2为肥胖，超重29例，肥胖39例。在饮食控制、加强运动基础上，随机将患者分为观察组与对照组，观察组（n=36）应用利拉鲁肽注射液每天1次皮下注射，从0.6mg 起始，一周后若未出现严重胃肠道反应（食欲下降、恶心、呕吐）且 FPG≥8mmol/L 或2hPG ≥11mmol/L 则加量至1.2mg/天，以此类推，最大剂量可达1.8mg/天；对照组（n=32）应用甘精胰岛素注射液每天1次皮下注射，联合二甲双胍餐后服用。观察两组治疗前后体重、BMI、血压、血糖控制及达标时间、TC、TG、LDL-C、HDL-C、HbA1c、24hUMA 的变化。记录用药期间低血糖发生情况及其它不良反应。结果：观察组治疗后体重、BMI、血压、TC、TG、LDL-C 均有所下降，差异有统计学意义，FPG、2hPG、HbA1c 及24hUMA 显著下降。对照组治疗后血压、FPG 及2hPG、HbA1c、24hUMA 均有所下降，差异有统计学意义，TC、TG、LDL-C 下降不明显，无统计学差异，体重、BMI、HDL-C 有所上升，但无统计学差异。治疗后观察组与治疗组血压、FPG 及2hPG、HbA1c、HDL-C、24hUMA 相比无统计学差异，观察组较治疗组体重、BMI、TC、TG、LDL-C 下降，有统计学差异。观察组较对照组空腹血糖的下降速度慢，而餐后血糖较对照组下降速度快，达标时间无统计学差异。观察组较对照组低血糖的发生率低，低血糖的程度两者之间无差异。观察组有3例出现食欲下降、恶心、呕吐，经减少剂量和对症治疗后症状缓解，无一例退出治疗。结论：GLP-1类似物利拉鲁肽能促进胰岛素分泌，控制血糖、血压、血脂、尿蛋白，具有降低体重、减少低血糖风险、心血管保护作用等优势，耐受性良好，对于超重或肥胖的2型糖尿病的治疗提供了新的治疗途径。

The liraglutide for curative effect analysis of overweight or obese type 2 diabetes

Objective Sample observation glucagon peptide 1 (glp-1) analogue, liraglutide of overweight or obese type 2 diabetes efficacy and safety. Methods In August 2012~August 2014 in our hospital endocrinology inpatient and outpatient treatment of 68 patients with type 2 diabetes, in BMI ≥ 24 kg/m2 for overweight, ≥28 Kg/m2 for obesity, overweight 29 cases, obesity 39 cases . On the basis of diet control, strengthen the movement, patients rando mLy divided into observation group and control group. Observation group (n= 36) applied the liraglutide injection subcutaneously 1 times a day, from 0.6 mg starting, after a week if not a severe gastrointestinal reaction (loss of appetite, nausea, vomiting) and FPG 8 or higher tendency tendency for L/L or 2 hPG acuity 11 has added amount to 1.2 mg/day, by parity of reasoning the maximum dose of 1.8 mg per day; The control group (n= 32) application of insulin injection subcutaneously 1 times a day, joint metfor min after a meal. Observe two groups before and after treatment the change of body weight, BMI, blood pressure, blood sugar control and standard time、TC、TG、LDL-C、HDL – C、HbA1c、24hUMA . Record during hypoglycemia occurrence and other adverse reactions. Results Observation group after treatment body weight, BMI, blood pressure, TC、TG、LDL-C all fell, The difference was statistically significant, FPG、2hPG、HbA1c and 24hUMA decreased significantly. Control group after treatment of blood pressure、FPG、2 hPG、HbA1c、24hUMA have declined, the difference was statistically significant, TC、TG、LDL - C decline is not obvious, no statistical difference, Body weight 、BMI、HDL - C has increased, but no statistical difference, Observation group and treatment group after treatment of blood pressure、FPG、2 hPG、HbA1c、HDL – C、24 Huma compared with no statistical difference, Observation group the treatment group of body weight、BMI、TC、TG、LDL - C drop, statistically significant. Observation group than control group in slow decline in fasting plasma glucose, and postprandial blood glucose down faster compared with control group, the standard time no statistical difference. Observation group was lower than those of control group in the incidence of low blood sugar, no difference between the degree of hypoglycemia. Observation group 3 cases with loss of appetite, nausea, vomit-ing, after reducing dose and symptomatic treatment of symptoms, no out of treatment. Conclusion Glp-1 analogues, liraglutide can promote insulin secretion, control blood sugar, blood pressure, blood fat, urine protein, reduce weight, reduce the risk of hy-poglycaemia and advantages of the cardiovascular protective effect, well tolerated, for overweight or obese type 2 diabetes treat-ment provides a new way.