摘要
目的:探讨艾托格列净联合二甲双胍对2型糖尿病合并肥胖患者糖脂代谢的影响。方法:选取2022年10月~2024年5月期间某院门诊收治的90例2型糖尿病合并肥胖患者作为研究对象,采用信封法随机分为对照组(自行服用中药或中成药治疗剔除2例,主动退出剔除1例,n=42)和观察组(自行采用中药/中成药/针灸治疗剔除3例,主动退出剔除1例,治疗期间多次血糖<3.9 mmol/L调整用药方案剔除1例,n=40)。对照组患者给予盐酸二甲双胍片治疗,观察组患者在对照组治疗基础上联合艾托格列净片治疗,均连续用药12周。比较两组患者血液学指标[空腹血糖(FBG)、糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)、空腹C肽(FCP)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、瘦素(LEP)、可溶性瘦素受体(sLR)、脂蛋白相关磷脂酶A2(Lp-PLA2)、纤维胶凝蛋白-3(Ficolin-3)、解整合素金属蛋白酶10(ADAM10)]、颈动脉内膜中层厚度、体重指数(BMI)、腰围、内脏脂肪面积、临床疗效及不良反应发生情况。结果:治疗后,两组患者FBG、HbA1c、FINS水平均降低(P<0.05),且观察组低于对照组(P<0.05);FCP水平均升高(P<0.05),且观察组高于对照组(P<0.05);观察组患者治疗后HDL-C、LDL-C水平均高于对照组(P<0.05)。两组患者LEP水平均降低(P<0.05),且观察组低于对照组(P<0.05);sLR水平均升高(P<0.05),且观察组高于对照组(P<0.05);颈动脉内膜中层厚度、Lp-PLA2、Ficolin-3、ADAM10水平、BMI、腰围、内脏脂肪面积均降低(P<0.05),且观察组低于对照组(P<0.05);观察组患者治疗总有效率(92.50%)高于对照组(76.19%,P<0.05);两组患者不良反应总发生率比较无统计学差异(P>0.05)。结论:艾托格列净联合二甲双胍治疗可显著提高2型糖尿病合并肥胖患者的临床疗效,改善糖代谢,调节瘦素相关因子表达,减少BMI和内脏脂肪,且不会增加不良反应的发生风险。
Objective:To investigate the effect of ertugliflozin combined with metformin on the glucose and lipid metabolism in obese patients with type 2 diabetes mellitus.Methods:A total of 90 patients with type 2 diabetes mellitus complicated with obesity who visited the hospital during October 2022 to May 2024 were selected and divided into the control group(n=42,after excluding 2 cases who self-administered traditional Chinese medicine/Chinese patent medicine,and one case of voluntary withdrawal)and the observation group(n=40,after excluding 3 cases who self-administered traditional Chinese medicine/Chinese patent medicine/acupuncture,1 case of voluntary withdrawal,1 case with medication regimen adjustments for multiple blood glucose<3.9 mmol/L during treatment)using envelope random method.Patients in the control group were treated with metformin hydrochloride tablets,while patients in the observation group were treated with ertugliflozin tablets in addition to the control treatment,both for 12 consecutive weeks.The hematological indexes[fasting blood glucose(FBG),glycosylated hemoglobin(HbA1c),fasting insulin(FINS),fasting C peptide(FCP),total cholesterol(TC),triglycerides(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),leptin(LEP),soluble leptin receptor(sLR),lipoprotein associated phospholipase A2(Lp-PLA2),Ficolin-3,disintegrin metalloproteinase 10(ADAM10)],carotid intima-media thickness,body mass index(BMI),waist circumference,visceral fat area,clinical efficacy and adverse reactions were compared between the two groups.Results:After treatment,the levels of FBG,HbA1c and FINS were decreased in both groups(P<0.05),and lower in the observation group than in the control group(P<0.05).FCP level was increased in both groups(P<0.05),and higher in the observation group than in the control group(P<0.05).The levels of HDL-C and LDL-C in the observation group were higher than those in the control group(P<0.05).LEP level was decreased in both groups(P<0.05),and lower in the observation group than in the control group(P<0.05).The level of sLR was increased in both groups(P<0.05),and higher in the observation group than in the control group(P<0.05).Carotid intima-media thickness,Lp-PLA2,Ficolin-3,ADAM10 level,BMI,waist circumference,visceral fat area were decreased in both groups(P<0.05),and lower in the observation group than in the control group(P<0.05).The total effective rate of the observation group(92.50%)was higher than that of the control group(76.19%,P<0.05).There was no statistically significant difference in the total incidence of adverse reactions between the two groups(P>0.05).Conclusion:Ertugliflozin combined with metformin can significantly improve the clinical efficacy,improve glucose metabolism,regulate the expression of leptin-related factors,reduce body weight and visceral fat in patients with type 2 diabetes mellitus complicated with obesity,without increasing the risk of adverse reactions.
作者
宋白利
彭慧芳
付留俊
曹慧芳
张文博
郭宇
SONG Bai-li;PENG Hui-fang;FU Liu-jun;CAO Hui-fang;ZHANG Wen-bo;GUO Yu(Department of Endocrinology,Clinical College of Henan University of Science and Technology/the First Affiliated Hospital o f Henan University of Science and Technology,Luoyang 471003,China)
出处
《中国合理用药探索》
2025年第3期35-42,共8页
Chinese Journal of Rational Drug Use
关键词
艾托格列净
肥胖
2型糖尿病
糖脂代谢
动脉粥样硬化
ertugliflozin
obesity
type 2 diabetes mellitus
glucose and lipid metabolism
atherosclerosis
