影响患者利拉鲁肽降糖疗效因素的回顾分析

目的：为促进利拉鲁肽合理应用提供依据，回顾性分析影响2型糖尿病（type 2 diabetic mellitus，T2DM）患者使用利拉鲁肽降糖疗效的因素。方法：以华东医院2019年1月至2020年8月间使用利拉鲁肽的T2DM患者为研究对象，采用回顾性分析方法，观察和比较患者首次使用利拉鲁肽3个月及以上前后的糖化血红蛋白（HbA1c）、BMI （身体质量指数）和体质量的差异，分成疗效达标（治疗后HbA1c<7%或下降幅度>1%）和疗效未达标组。通过独立样本t检验和卡方检验分析组间基线数据差异，包括基本信息、检验指标，还有合并用药情况，Logistic回归法筛选出降糖疗效的影响因素。结果：在所有纳入研究的患者中，HbA1c、BMI和体质量指标分别下降（1.13±2.04）%、（0.77±1.48） kg·m^-2、（2.41±4.04） kg。140例（60.9%）患者达到预期的降糖目标，90例（39.1%）未达标。研究还发现2组患者的年龄、DM病程、体质量、性别和联用胰岛素的差异具有统计学意义（P=0.005、P=0.000、P=0.044、P=0.016、P=0.011），Logistic回归分析显示年龄和联用胰岛素对利拉鲁肽降糖疗效影响有显著意义P=0.004，OR=0.907，95% CI （0.848，0.969）；P=0.000，OR=0.151，95% CI （0.058，0.396）]。结论：首次使用利拉鲁肽时，患者的年龄、DM病程、体质量、性别和联用胰岛素与其降糖疗效达标相关，年龄和联用胰岛素是影响利拉鲁肽疗效的主要因素。临床个体化用药时，可评估以上因素对疗效的影响。

Retrospective analysis of the factors influencing thehypoglycemic effect of liraglutide on patients

OBJECTIVE To explore retrospectively the influencing factors of hypoglycemic effect of liraglutide on type 2 diabetes mellitus(T2DM) patients and provide rationales for promoting the rational use of liraglutide.METHODS A retrospective analysis was performed for 230 T2DM patients receiving liraglutide from January 2019 to August 2020.There were 105 males and 125 females with an average age of(55.91±12.19) years.The differences of glycosylated hemoglobin(HbA1c), body mass index(BMI) and body weight were compared before and after an initial use of liraglutide for 3 months or more.They were divided into two groups of goal-attaining(HbA1c<7% or decrease>1% after treatment) and goal-non-attaining.The inter-group differences of baseline data were analyzed by independent sample T-test and chi-square test, including basic profiles, test parameters and co-medications.The influencing factors of hypoglycemic efficacy by Logistic regression analysis were performed.RESULTS The parameters of HbA1c, BMI and body weight improved by(1.13±2.04)%, (0.77±1.48) kg·m^-2 and(2.41±4.04) kg respectively.And 140(60.9%) patients attained the desired hypoglycemic targets while 90(39.1%) patients failed.Age, duration of T2DM, body weight, gender and combined use of insulin were significantly different between two groups(P=0.005, P=0.000, P=0.044, P=0.016, P=0.011).Logistic regression analysis showed that age and combined use of insulin had significant effects on the efficacy of liraglutideP=0.004, OR=0.907, 95% CI(0.848, 0.969);P=0.000, OR=0.151, 95%CI(0.058, 0.396)].CONCLUSION Age, duration of diabetes, body weight, gender and combined insulin are correlated with hypoglycemic efficacy of liraglutide.Age and combined insulin are major factors affecting the hypoglycemic efficacy of liraglutide.The influence of the above factors on the curative effect of liaglutide may be evaluated during clinical individualized medications.