胰高血糖素样肽1受体激动剂对2型糖尿病合并超重/肥胖患者不同部位脂肪分布及肌肉含量的影响

目的探讨2型糖尿病（T2DM）合并超重/肥胖患者使用胰高血糖素样肽-1受体激动剂（GLP-1RAs）治疗对不同部位的脂肪分布及肌肉含量的影响。方法回顾性调查2014年12月~2015年9月于南方医科大学南方医院内分泌代谢科诊断为T2DM且体质量指数（BMI）≥24 kg/m2的76例患者,按BMI分为超重组（BMI 24~27.9 kg/m2）14例、肥胖组（BMI 28~31.9 kg/m2）35例及严重肥胖组（BMI≥32 kg/m2）27例,予GLP-1RA治疗3.0~29.0周（平均8.9周）,比较各组治疗前后体质量、BMI、腰臀比、内脏脂肪指数、身体脂肪率及四肢肌肉率的变化。结果治疗前,各组的性别、年龄、身高、糖脂代谢指标、其他降糖药使用等均无显著统计学差异。治疗后,各组体质量均明显降低,但仅超重组和肥胖组差异有统计学意义（P<0.05）;各组BMI和内脏脂肪指数均较前明显降低（P<0.05）;超重组腰臀比较前明显降低（P<0.05）;肥胖组与严重肥胖组的身体脂肪率及各部位脂肪率均明显下降且肌肉率明显增加（P<0.05）。与超重组相比,肥胖组身体脂肪率和内脏脂肪指数下降更明显（P<0.05）,肥胖组与严重肥胖组的肢体皮下脂肪率降低及肌肉率升高更明显（P<0.05）。结论GLP-1RAs可显著改善T2DM合并超重/肥胖患者各部位的脂肪沉积,且BMI指数越高的患者体质构成的改善越明显。

Effect of glucagon-like peptide 1 receptor agonists on body fat redistribution and musclemass in overweight and obese type 2 diabetic patients

Objective To investigate the effect of glucagon-like peptide 1 receptor agonists (GLP-1RAs) on body fatredistribution and muscle mass in overweight/obese patients with type 2 diabetes (T2DM). Methods We retrospectivelyanalyzed the data of 76 patients with body mass indexes (BMI)≥24 kg/m2, who had an established diagnosis of T2DM in ourdepartment between December, 2014 and September, 2015. We divided these patients according to their BMI in overweightgroup (BMI of 24-27.9 kg/m2, n=14), obese group (BMI of 28-31.9 kg/m2, n=35) and severely obese group (BMI≥32 kg/m2, n=27).All the patients received treatment with GLP-1RAs (Exenatide or Liraglutide) for 3.0 to 29.0 weeks (mean 8.9 weeks), and theirblood glucose, HbA1c and serum lipids were analyzed. For each patient, the fat and muscle masses were analyzed using ahuman body composition analyzer (JAWON-IOI353, Korea) before and after GLP-1RAs treatment. Results Treatment withGLP-1RAs significantly decreased BMI and visceral adiposity index (VAI) in all the patients in the 3 groups (P<0.05). Thetreatment significantly decreased the body weight in the overweight group and obese group by 2.70 kg (0.60-4.95 kg) and 2.65kg (1.45-6.40 kg), respectively (P<0.05), and significantly decreased the waist-to-hip ratio (WHR) in the overweight group (P<0.05). The obese and severely obese patients showed significantly decreased percentage body fat (including both subcutaneousand visceral fat) and increased muscle mass after the treatment (P<0.05). Compared with those in the overweight group, thepercentage body fat and VAI were significantly decreased in the obese group after the treatment (P<0.05), and the percentageof subcutaneous fat reduced and the muscle ratio increased more obviously in the obese and severely obese patients (P<0.05).Conclusion GLP-1RAs treatment can significantly lower BMI and improve body fat distribution in obese patients with T2DM,especially in patients with a greater BMI.