维格列汀联合艾塞那肽治疗2型糖尿病的效果及对血清胰岛细胞抗体和胰高血糖素样肽-1的影响

目的探究维格列汀联合艾塞那肽治疗2型糖尿病(T2DM)的效果及对血清胰岛细胞抗体(ICA)和胰高血糖素样肽-1(GLP-1)水平的影响。方法选择二甲双胍控制不佳的T2DM患者共90例,按照随机数字表法均分为对照组和观察组。对照组使用维格列汀治疗,观察组在对照组治疗的基础上联合艾塞那肽治疗。比较2组患者治疗前后血糖、胰岛素和胰岛素抵抗相关指标,检测并比较治疗前后血清GLP-1和ICA的表达水平。结果治疗后2组血糖生化指标均显著降低(P<0.05),且观察组空腹血糖(FPG)、2 h血糖(2 h FPG)和糖化血红蛋白(HbA1c)显著低于对照组(P<0.05)。治疗后2组胰岛素相关指标改善,观察组2 h胰岛素(INS)和胰岛β细胞功能指数(HOMA-β)显著高于对照组,胰岛素抵抗指数(HOMA-IR)显著低于对照组(P<0.05)。治疗前2组血清GLP-1水平和ICA阳性率无显著差异,治疗后均有好转,治疗后观察组的血清GLP-1水平显著高于对照组,ICA阳性率显著低于对照组(P<0.05)。2组不良反应发生情况无显著差异。结论维格列汀联合艾塞那肽能更有效地提高GLP-1水平,并降低ICA表达,提示联合治疗具有改善胰岛β细胞功能的作用。

Effect of vildagliptin combined with exenatide on patients with type 2 diabetes mellitus and on serum islet cell antibodiesand glucagon-like peptide-1 levels

Objective To investigate the effects of vildagliptin combined with exenatide on patients with type 2 diabetes mellitus and its effect on serum islet cell antibodies(ICA)and glucagon-like peptide-1(GLP-1)levels.Methods A total of 90 patients with poorly controlled metformin-treated T2DM who were treated in our hospital were enrolled in the control group and the observation group according to the random number table method.The control group were treated with vildagliptin,and the observation group were treated with exenatide on the basis of the control group.The blood glucose,insulin and insulin resistance related indexes were compared before and after treatment between the 2 groups.The serum GLP-1 and ICA expression levels were measured and compared before and after treatment.Results The blood glucose biochemical indexes of the 2 groups were significantly decreased after treatment(P<0.05),and the fasting plasma glucose(FPG),2 h FPG and glycosylated hemoglobin(HbA1c)in the observation group were significantly lower than those in the control group(P<0.05).After treatment,the insulin-related indexes of the 2 groups were improved.After treatment,the insulin(INS)and homeostasis model assessment-β(HOMA-β)in the observation group were significantly higher than those in the control group and homeostasis model assessment-insulin resistance(HOMA-IR)was significantly lower than in the control group(P<0.05).There was no significant difference in serum GLP-1 level and ICA positive rate between the 2 groups before treatment(P>0.05),and all of them improved after treatment.After treatment,the serum GLP-1 level in the observation group was significantly higher than that in the control group and the ICA positive rate was significantly lower than that in the control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the 2 groups(P>0.05).Conclusion The combination of vildagliptin and exenatide can increase the level of GLP-1 more effectively.The combined therapy can reduce ICA expression,suggesting that the combination therapy have an effect on improving islet beta cell function.