利拉鲁肽对血糖控制不佳的2型糖尿病患者胰岛β细胞功能及血糖波动的作用研究
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摘要
目的探究血糖控制不佳的2型糖尿病患者接受利拉鲁肽治疗对其胰岛β细胞功能以及血糖波动的影响。方法 2型糖尿病患者100例根据其治疗方案的不同分为对照组和试验组,每组50例。对照组在基础治疗之上实施二甲双胍治疗,试验组则实施利拉鲁肽治疗,观察2组治疗前后血糖[空腹血糖(FBG)、餐后2 h血糖(2 h PBG)、糖化血红蛋白(Hb A1c)]、体重指数(BMI)、胰岛素水平(FIns)、血压、血脂[总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、稳态模型胰岛素β细胞分泌指数(HOMA-β)、稳态模型胰岛素抵抗指数(HOMA-IR)水平和胰岛素用量]。结果 2组2型糖尿病患者的血糖水平均较治疗前明显改善,其中试验组血糖水平改善程度明显优于对照组(P <0. 05);试验组2型糖尿病患者治疗后的BMI、FIns水平均较治疗前改善,且明显优于对照组(P <0. 05)。2组治疗前后的血压水平比较,差异无统计学意义(P> 0. 05); 2组治疗前后的TC、HDL-C、LDL-C水平比较,差异无统计学意义(P> 0. 05)。其中试验组治疗后的TG水平明显较治疗前改善,且优于对照组(P <0. 05); 2组2型糖尿病患者治疗后的HOMA-β、HOMA-IR均较治疗前改善,胰岛素使用量均明显降低,其中试验组HOMA-β、HOMA-IR改善程度、胰岛素使用量降低量均优于对照组(P <0. 05)。结论血糖控制不佳的2型糖尿病患者接受利拉鲁肽治疗,能够有效对其血糖水平进行控制,对其胰岛素抵抗进行改善,促进其胰岛β细胞功能的增强。
Objective To investigate the effects of liraglutide on the function of beta cell of islet and blood glucose fluctuation in patients with type 2 diabetes mellitus with poor blood glucose control. Methods A total of 100 patients with type 2 diabetes mellitus were enrolled as research objects,according to different therapeutic schedules,these patients were divided into control group and experimental group,with 50 patients in each group. The patients in both groups were treated by basic treatment,and the patients in control group were treated by oral diformin,however,the patients in experimental group were treated by oral liraglutide. The blood glucose levels including FBG,2 h PBG,HbA1c,and BMI,Fins,blood pressure,blood lipid including TC,TG,HDL-C,LDL-C,and HOMA-β,HOMA-IR and insulin dosage before and after treatment were observed and compared between the two groups. Results The blood glucose levels of patients in both groups were significantly improved compared,as compared with those before treatment,moreover,the improvement degree in experimental group was superior to that in control group( P < 0. 05). After treatment the levels of BMI and FIns in experimental group were superior to those in control group( P < 0. 05). There were no significant differences in the blood pressure levels in both groups before and after treatment( P > 0. 05). Moreover there were no significant differences in the levels of TC,HDL-C and LDL-C in both groups before and after treatment( P > 0. 05). After treatment the TG levels in experimental group were superior to those in control group( P < 0. 05). After treatment the levels of HOMA beta,HOMA IR were obviously improved in both groups,and insulin dosage was significantly decreased,moreover,which in experimental group were superior to those in control group( P < 0. 05).Conclusion The liraglutide can effectively control the blood glucose levels in patients with type 2 diabetes mellitus with poor blood glucose control,and improve insulin resistance to promote islet beta cell function.
Objective To investigate the effects of liraglutide on the function of beta cell of islet and blood glucose fluctuation in patients with type 2 diabetes mellitus with poor blood glucose control. Methods A total of 100 patients with type 2 diabetes mellitus were enrolled as research objects,according to different therapeutic schedules,these patients were divided into control group and experimental group,with 50 patients in each group. The patients in both groups were treated by basic treatment,and the patients in control group were treated by oral diformin,however,the patients in experimental group were treated by oral liraglutide. The blood glucose levels including FBG,2 h PBG,HbA1c,and BMI,Fins,blood pressure,blood lipid including TC,TG,HDL-C,LDL-C,and HOMA-β,HOMA-IR and insulin dosage before and after treatment were observed and compared between the two groups. Results The blood glucose levels of patients in both groups were significantly improved compared,as compared with those before treatment,moreover,the improvement degree in experimental group was superior to that in control group( P < 0. 05). After treatment the levels of BMI and FIns in experimental group were superior to those in control group( P < 0. 05). There were no significant differences in the blood pressure levels in both groups before and after treatment( P > 0. 05). Moreover there were no significant differences in the levels of TC,HDL-C and LDL-C in both groups before and after treatment( P > 0. 05). After treatment the TG levels in experimental group were superior to those in control group( P < 0. 05). After treatment the levels of HOMA beta,HOMA IR were obviously improved in both groups,and insulin dosage was significantly decreased,moreover,which in experimental group were superior to those in control group( P < 0. 05).Conclusion The liraglutide can effectively control the blood glucose levels in patients with type 2 diabetes mellitus with poor blood glucose control,and improve insulin resistance to promote islet beta cell function.
引文
1陈频,陈晨,邵珠林,等.利拉鲁肽对新诊断的糖化血红蛋白>9%的2型糖尿病患者的有效性及安全性.中华内科杂志,2015,54:307-312.
2毛培军,李桂玲,黄倩,等.利拉鲁肽联合门冬胰岛素30治疗难治性2型糖尿病的临床疗效及安全性评价.中国临床药理学杂志,2015,31:1578-1581.
3李春伶,李桂平,林俊宇,等.格列美脲与二甲双胍联合利拉鲁肽治疗2型糖尿病合并高脂血症患者的临床疗效.实用心脑肺血管病杂志,2017,25:117-120.
4 Thong KY,Gupta PS,Blann AD,et al.The influence of age and metformin treatment status on reported gastrointestinal side effects with liraglutide treatment in type 2 diabetes.Diabetes research and clinical practice,2015,109:124-129.
5韩蕊,徐志芳,祁范范,等.2型糖尿病大鼠胸主动脉磷酸化p38丝裂素活化蛋白激酶蛋白表达及利拉鲁肽对其干预作用的研究.中国糖尿病杂志,2016,24:556-560.
6张伟,马维青.胰高糖素样肽1类似物对2型糖尿病患者体质量的影响及作用机制研究进展.山东医药,2015,59:92-95.
7马英丽.利拉鲁肽对2型糖尿病合并低T3综合征患者糖化血红蛋白和胰岛β细胞功能及体脂的影响分析.中华细胞与干细胞杂志(电子版),2017,7:141-145.
8姚璐,田国祥,武云涛,等.二甲双胍分别联合利拉鲁肽及甘精胰岛素治疗2型糖尿病的临床观察.中国循证心血管医学杂志,2015,8:100-102.
9 Kimura T,Kaneto H,Shimoda M,et al.Protective effects of pioglitazone and/or liraglutide on pancreatic beta-cells in db/db mice:Comparison of their effects between in an early and advanced stage of diabetes.Molecular and Cellular Endocrinology,2015,400:78-89.
10陈英刚,吕春苗,陈海君,等.利拉鲁肽联合诺和锐30对2型糖尿病患者糖代谢指标和胰岛功能及生化指标的影响.中国慢性病预防与控制,2016,24:671-674.
11陈频,黄勤,徐向进,等.利拉鲁肽联合人脐带间充质干细胞治疗对2型糖尿病患者糖代谢及胰岛β细胞功能的作用.中华内科杂志,2016,55:349-354.
12曲建昌,李丽,赵蕾,等.胰高血糖素样肽1类似物对伴超重或肥胖初发2型糖尿病患者的疗效.中国医药,2017,12:1012-1014.
13 Rizvi AA,Patti AM,Giglio RV,et al.Liraglutide improves carotid intima-media thickness in patients with type 2 diabetes and nonalcoholic fatty liver disease:an 8-month prospective pilot study.Expert opinion on biological therapy,2015,15:1391-1397.
14石志平,杨昱,雷营,等.利拉鲁肽降低2型糖尿病伴非酒精性脂肪性肝病大鼠肝脏磷酸化c-Jun氨基末端激酶的蛋白表达.中华糖尿病杂志,2016,8:548-553.
15 Vedtofte L,Knop FK,Vilsbll T.Fixed combination of insulin and a glucagon-like peptide-1 analog for the treatment of type 2 diabetes,exemplified by insulin degludec and liraglutide.Expert review of clinical pharmacology,2015,8:273-282.
16张渭涛,贾真,宁江颖,等.2型糖尿病患者加用利拉鲁肽治疗对胰岛β细胞功能和每日胰岛素用量的影响.中国慢性病预防与控制,2017,25:863-866.
17 Lapolla A,Frison V,Bettio M,et al.Correlation between baseline characteristics and clinical outcomes in a large population of diabetes patients treated with liraglutide in a real-world setting in italy.Clinical therapeutics,2015,37:574-584.
18陈频,黄山,温代芬,等.脐带间充质干细胞联合利拉鲁肽对2型糖尿病大鼠模型胰腺炎症损伤的保护作用.中华内分泌代谢杂志,2016,32:1003-1009.
19张卫欢,李秋云,杨春伟,等.大柴胡汤加减联合利拉鲁肽对肥胖2型糖尿病患者胰岛素抵抗、β-细胞功能和低度炎症反应的影响.现代中西医结合杂志,2018,27:23-26,30.
20王平,赵蕾,徐锌,等.地特胰岛素联合利拉鲁肽治疗血糖控制不佳2型糖尿病患者的临床观察.中国糖尿病杂志,2015,23:524-526.
2毛培军,李桂玲,黄倩,等.利拉鲁肽联合门冬胰岛素30治疗难治性2型糖尿病的临床疗效及安全性评价.中国临床药理学杂志,2015,31:1578-1581.
3李春伶,李桂平,林俊宇,等.格列美脲与二甲双胍联合利拉鲁肽治疗2型糖尿病合并高脂血症患者的临床疗效.实用心脑肺血管病杂志,2017,25:117-120.
4 Thong KY,Gupta PS,Blann AD,et al.The influence of age and metformin treatment status on reported gastrointestinal side effects with liraglutide treatment in type 2 diabetes.Diabetes research and clinical practice,2015,109:124-129.
5韩蕊,徐志芳,祁范范,等.2型糖尿病大鼠胸主动脉磷酸化p38丝裂素活化蛋白激酶蛋白表达及利拉鲁肽对其干预作用的研究.中国糖尿病杂志,2016,24:556-560.
6张伟,马维青.胰高糖素样肽1类似物对2型糖尿病患者体质量的影响及作用机制研究进展.山东医药,2015,59:92-95.
7马英丽.利拉鲁肽对2型糖尿病合并低T3综合征患者糖化血红蛋白和胰岛β细胞功能及体脂的影响分析.中华细胞与干细胞杂志(电子版),2017,7:141-145.
8姚璐,田国祥,武云涛,等.二甲双胍分别联合利拉鲁肽及甘精胰岛素治疗2型糖尿病的临床观察.中国循证心血管医学杂志,2015,8:100-102.
9 Kimura T,Kaneto H,Shimoda M,et al.Protective effects of pioglitazone and/or liraglutide on pancreatic beta-cells in db/db mice:Comparison of their effects between in an early and advanced stage of diabetes.Molecular and Cellular Endocrinology,2015,400:78-89.
10陈英刚,吕春苗,陈海君,等.利拉鲁肽联合诺和锐30对2型糖尿病患者糖代谢指标和胰岛功能及生化指标的影响.中国慢性病预防与控制,2016,24:671-674.
11陈频,黄勤,徐向进,等.利拉鲁肽联合人脐带间充质干细胞治疗对2型糖尿病患者糖代谢及胰岛β细胞功能的作用.中华内科杂志,2016,55:349-354.
12曲建昌,李丽,赵蕾,等.胰高血糖素样肽1类似物对伴超重或肥胖初发2型糖尿病患者的疗效.中国医药,2017,12:1012-1014.
13 Rizvi AA,Patti AM,Giglio RV,et al.Liraglutide improves carotid intima-media thickness in patients with type 2 diabetes and nonalcoholic fatty liver disease:an 8-month prospective pilot study.Expert opinion on biological therapy,2015,15:1391-1397.
14石志平,杨昱,雷营,等.利拉鲁肽降低2型糖尿病伴非酒精性脂肪性肝病大鼠肝脏磷酸化c-Jun氨基末端激酶的蛋白表达.中华糖尿病杂志,2016,8:548-553.
15 Vedtofte L,Knop FK,Vilsbll T.Fixed combination of insulin and a glucagon-like peptide-1 analog for the treatment of type 2 diabetes,exemplified by insulin degludec and liraglutide.Expert review of clinical pharmacology,2015,8:273-282.
16张渭涛,贾真,宁江颖,等.2型糖尿病患者加用利拉鲁肽治疗对胰岛β细胞功能和每日胰岛素用量的影响.中国慢性病预防与控制,2017,25:863-866.
17 Lapolla A,Frison V,Bettio M,et al.Correlation between baseline characteristics and clinical outcomes in a large population of diabetes patients treated with liraglutide in a real-world setting in italy.Clinical therapeutics,2015,37:574-584.
18陈频,黄山,温代芬,等.脐带间充质干细胞联合利拉鲁肽对2型糖尿病大鼠模型胰腺炎症损伤的保护作用.中华内分泌代谢杂志,2016,32:1003-1009.
19张卫欢,李秋云,杨春伟,等.大柴胡汤加减联合利拉鲁肽对肥胖2型糖尿病患者胰岛素抵抗、β-细胞功能和低度炎症反应的影响.现代中西医结合杂志,2018,27:23-26,30.
20王平,赵蕾,徐锌,等.地特胰岛素联合利拉鲁肽治疗血糖控制不佳2型糖尿病患者的临床观察.中国糖尿病杂志,2015,23:524-526.