摘要
目的观察利拉鲁肽在新诊断2型糖尿病（T2DM）持续皮下胰岛素输注（CSII）短期强化治疗后获得长期临床缓解中的作用。方法2014年3月至2015年3月入选符合标准的新诊断T2DM患者85例，经CSII强化治疗2周后出院，出院时按随机数字表法分为利拉鲁肽组（40例）和二甲双胍组（45例），继续接受单药治疗12周后停用，仅生活方式干预；出院后第24周门诊随访两组空腹血糖（FPG）、餐后2 h血糖（2hPG）、糖化血红蛋白（HbA1c）、体质指数（BMI）、空腹C肽（FCP）、餐后2 h C肽（2hCP）及稳态模型β细胞功能指数（HOMA-β）的差异；出院后第48周门诊再次随访比较两组FPG、2hPG、HbA1c、BMI、FCP、2hCP、HOMA-β及临床缓解率间的差异。计量资料两独立样本首先进行方差齐性检验，方差齐时组间比较则采用t检验。结果入选患者经CSII短期强化治疗后，出院时FPG、2hPG较入院时明显下降；出院时两组在年龄、BMI、病程等一般资料方面比较差异均无统计学意义。出院后24周，两组FPG、HbA1c、BMI比较差异均无统计学意义，利拉鲁肽组2hPG显著低于二甲双胍组[（8.4±1.5）比（11.2±2.2） mmol/L，t=4.26，P〈0.05]，而FCP、2hCP、HOMA-β则显著高于二甲双胍组[分别为（2.2±0.3）比（1.8±0.3） μg/L、（4.2±0.7）比（3.6±0.5） μg/L和76±7比56±5，t=4.35、4.70、6.92，均P〈0.05]。出院后48周，利拉鲁肽组FPG、2hPG、HbA1c、BMI均显著低于二甲双胍组[（7.3±1.3）比（8.1±1.8） mmol/L、（9.5±1.4）比（11.5±2.1） mmol/L、6.9%±0.6%比7.3%±0.9%、（24.8±1.4）比（26.2±2.1） kg/m2，t=4.73-6.81，均P〈0.05]；而FCP、2hCP、HOMA-β均高于二甲双胍组[（2.2±0.4）比（1.8±0.2）μg/L、（3.9±0.8）比（3.3±0.5）μg/L、68±8比50±5，t=9.05、6.83、4.92，均P〈0.05]；利拉鲁肽组临床缓解率高于二甲双胍组[67.5%（27/40）比44.4%（20/45），χ2=4.56，P〈0.05]。结论利拉鲁肽有利于新诊断T2DM强化治疗后的胰岛功能持续改善，维持血糖长期达标，延长临床缓解期。
To observe the effect of liraglutide in the long-term clinical remission after short-term continuous subcutaneous insulin infusion （CSII） in newly diagnosed type 2 diabetes mellitus （T2DM）.MethodsEighty-five newly diagnosed T2DM patients from March 2014 to March 2015 in line with the inclusion criteria were discharged after two weeks＇ CSII intensive therapy. The patients were randomly divided into two groups according to the random number table method： the liraglutide group （40 cases） and the metformin group （45 cases）, the patients discontinued drugs after 12 weeks＇ continuous monotherapy and lifestyle intervention. Fasting plasma glucose （FPG）, 2-hours postprandial plasma glucose （2hPG）, glycated hemoglobin A1c （HbA1c）, body mass index （BMI）, fasting C-peptide （FCP）, 2-hours postprandial C-peptide （2hCP） and homeostasis model assessment of β cell function （HOMA-β） during the outpatient follow-up visit at 24th week were compared between the two groups. The up-mentioned indexes and clinical remission rate at 48th-week outpatient follow-up were compared between the two groups. The data were compared between the two groups by using t test when equal variance was confirmed with homogeneity test of variances. ResultsAfter short-term intensive therapy, the FPG and 2hPG decreased significantly in comparison with those at hospitalization. There was no significant difference between the two groups in age, BMI, duration of disease and other general information. At the 24th week, there was no differences in FPG, HbA1c and BMI between the two groups, the 2hPG was remarkably lower in the liraglutide group than that in the metformin group [（8.4±1.5） vs （11.2±2.2） mmol/L, t=4.26, P〈0.05], while the FCP, 2hCP and HOMA-β were significantly lower in the liraglutide group than those in the metformin group [（2.2±0.3） vs （1.8±0.3） μg/L, （4.2±0.7） vs （3.6±0.5） μg/L, 76±7 vs 56±5, t=4.35, 4.70, 6.92, all P〈0.05]. The FPG, 2hPG, HbA1c, and BMI were notably lower in the liraglutide group than those in the metformin group at the 48th week [（7.3±1.3） vs （8.1±1.8） mmol/L, （9.5±1.4） vs （11.5±2.1） mmol/L, 6.9%±0.6% vs 7.3%±0.9%, （24.8±1.4） vs （26.2±2.1） kg/m2, t=4.73-6.81, all P〈0.05], while FCP, 2hCP and HOMA-β were significantly higher [（2.2±0.4） vs （1.8±0.2） μg/L, （3.9±0.8） vs （3.3±0.5） μg/L, 68±8 vs 50±5, t=9.05, 6.83, 4.92, all P〈0.05]. Clinical remission rate was markedly higher in the liraglutide group than that in the metformin group [67.5% （27/40） vs 44.4% （20/45）, χ2=4.56, P〈0.05].ConclusionLiraglutide is beneficial in the continuous improvement of pancreatic islet function and long-term clinical remission after intensive therapy in newly-diagnosed T2DM.
作者
沈艳军
田亚强
李英
李明
安丰田
Shen Yanjun Tian Yaqiang Li Ying Li Ming An Fengtian(Department of Endocrinology, Liaocheng People＇s Hospital, Liaocheng 252000, Chin)
出处
《中华糖尿病杂志》
CAS
CSCD
2017年第9期550-554,共5页
CHINESE JOURNAL OF DIABETES MELLITUS
关键词
糖尿病
2型
利拉鲁肽
二甲双胍
强化治疗
Diabetes mellitus, type 2
Liraglutide
Metformin
Intensive therapy
