摘要
目的对比分析达格列净和西格列汀治疗超重2型糖尿病(T2DM)患者的临床疗效。方法回顾性纳入2021年1月至2021年12月商洛市中心医院收治的身体质量指数≥24.0 kg/m2的122例T2DM患者,根据治疗方法不同分成A组(63例)和B组(59例),A组为常规干预+二甲双胍、西格列汀治疗,B组为常规干预+二甲双胍、达格列净治疗,两组均治疗24周。比较治疗前后两组患者的体质量、血压、糖代谢指标(空腹血糖、糖化血红蛋白、空腹胰岛素)、血尿酸、尿白蛋白/肌酐比值、血脂(甘油三酯、总胆固醇、低密度脂蛋白胆固醇与高密度脂蛋白胆固醇)、血清脂联素、肿瘤坏死因子α、胰岛β细胞功能指标(早时相胰岛素分泌指数、胰岛素曲线下面积)及不良反应发生情况。结果治疗24周后,B组体质量、收缩压、舒张压[(74.24±7.33)kg、(120.73±14.51)mmHg(1 mmHg=0.133 kPa)、(64.20±5.03)mmHg]均低于A组[(77.60±7.25)kg、(130.69±13.46)mmHg、(66.18±4.05)mmHg](t=2.545、3.933、2.402,均P<0.05);B组甘油三酯、血尿酸、尿白蛋白/肌酐比值[(1.67±0.49)mmol/L、(422.72±38.03)μmo/L、(46.28±6.56)mg/g]均低于A组[(1.86±0.45)mmol/L、(449.73±52.02)μmo/L、(49.52±7.13)mg/g](t=2.233、3.265、2.607,均P<0.05);B组肿瘤坏死因子α[(1.53±0.49)ng/L]低于A组[(1.74±0.45)ng/L](t=2.468,P<0.05),脂联素、早时相胰岛素分泌指数、胰岛素曲线下面积[(5.29±1.03)μg/mL、(4.78±0.90)mU/mmol、(102.45±16.59)U/mL·(180 min)]高于A组[(4.64±1.19)μg/mL、(3.96±0.83)mU/mmol、(90.44±15.74)U/mL·(180 min)](t=3.216、5.235、4.103,均P<0.05)。A组和B组的不良反应发生率分别为12.70%(8/63)和16.95%(10/59),差异无统计学意义(χ^(2)=0.438,P=0.508)。结论达格列净与西格列汀治疗超重T2DM患者的降糖疗效确切,二者均有良好的安全性;达格列净在控制体质量、血压、甘油三酯、血尿酸、尿白蛋白/肌酐比值水平,改善微炎症状态及脂肪细胞功能方面具有优势。
Objective To compare the efficacy of dapagliflozin and sitagliptin in the treatment of overweight patients with type 2 diabetes mellitus(T2DM).Methods A total of 122 T2DM patients with body mass index no less than 24.0 kg/m2 treated in Shangluo Central Hospital from January 2021 to December 2021 were enrolled in the study and divided into the group A with 63 cases and the group B with 59 cases according to the treatment method.The group A was treated with conventional intervention plus metformin and sitagliptin,while the group B was given conventional intervention plus metformin and dapagliflozin.Both groups were treated for 24 weeks.The body weight,blood pressure,glycometabolism indexes(fasting blood glucose,glycated haemoglobin,fasting insulin),serum uric acid(SUA),urinary albumin-to-creatinine ratio(UACR),lipid indexes(triglycerides(TG),total cholesterol(TC),low-density lipoprotein cholesterol,high-density lipoprotein cholesterol),serum adiponectin,tumor necrosis factor-α(TNF-α),pancreaticβ-cell function indexes(early-phase insulin secretion index,area under the insulin curve)and incidence of adverse reactions were compared between the two groups before and after treatment.Results The body mass,systolic blood pressure and diastolic blood pressure of the group B were respectively(74.24±7.33)kg,(120.73±14.51)mmHg(1 mmHg=0.133 kPa)and(64.20±5.03)mmHg after treatment for 24 weeks,lower than(77.60±7.25)kg,(130.69±13.46)mmHg and(66.18±4.05)mmHg of the group A(t=2.545,3.933,2.402,all P<0.05).The levels of TG,SUA and UACR of the group B were respectively(1.67±0.49)mmol/L,(422.72±38.03)μmo/L and(46.28±6.56)mg/g after treatment for 24 weeks,lower than(1.86±0.45)mmol/L,(449.73±52.02)μmo/L and(49.52±7.13)mg/g of the group A(t=2.233,3.265,2.607,all P<0.05).The TNF-αlevel of the group B was(1.53±0.49)ng/L after treatment for 24 weeks,lower than(1.74±0.45)ng/L of the group A(t=2.468,P<0.05),while the levels of adiponectin,early-phase insulin secretion index and area under the insulin curve of the group B were respectively(5.29±1.03)μg/mL,(4.78±0.90)mU/mmol and(102.45±16.59)U/mL·(180 min),higher than(4.64±1.19)μg/mL,(3.96±0.83)mU/mmol and(90.44±15.74)U/mL·(180 min)of the group A(t=3.216,5.235,4.103,all P<0.05).The incidence of adverse reactions was 12.70%(8/63)in the group A and 16.95%(10/59)in the group B,with no statistically significant difference between the two groups(χ^(2)=0.438,P=0.508).Conclusion Both dapagliflozin and sitagliptin provide effective glycemic control with a favorable safety profile in the overweight patients with T2DM.Dapagliflozin has advantages in the control of body weight,blood pressure,and the reduction of TG,blood uric acid and UACR as well as the improvement of microinflammatory state and adipocyte function.
作者
王晓东
南飞宁
WANG Xiaodong;NAN Feining(Department of Endocrinology,Shangluo Central Hospital,Shangluo 726000,China;Department of Endocrinology,Northwest University First Hospital,Xi’an 710043,China)
出处
《中国药物应用与监测》
2025年第9期1512-1516,共5页
Chinese Journal of Drug Application and Monitoring
关键词
达格列净
西格列汀
2型糖尿病
脂联素
肿瘤坏死因子Α
胰岛Β细胞功能
dapagliflozin
sitagliptin
type 2 diabetes mellitus
adiponectin
tumor necrosis factor-α
pancreaticβ-cell function
