利拉鲁肽联合二甲双胍对2型糖尿病合并肥胖患者胰岛β细胞功能以及内脏脂肪水平的影响

目的分析利拉鲁肽联合二甲双胍对2型糖尿病（T2DM）合并肥胖患者胰岛β细胞功能以及内脏脂肪水平的影响。 方法选取重庆两江新区第一人民医院2016年3月至2018年3月收治的194例T2DM合并肥胖患者，将其随机分为研究组、对照组，各97例，均给予为期16周的二甲双胍治疗，研究组加用利拉鲁肽皮下注射。比较两组患者治疗前后血糖、胰岛β细胞功能指数（HOMA-β）、内脏脂肪水平（VFL）等指标变化，总结利拉鲁肽在T2DM合并肥胖治疗中的临床价值。计数资料采用卡方检验，计量资料采用t检验。 结果研究组不良反应发生率为29.90﹪，对照组为23.71﹪，组间比较差异无统计学意义（χ²= 0.946，P > 0.05）。两组患者治疗后FPG、2 hPG、BMI均较治疗前下降，研究组治疗后FPG、2 hPG、BMI分别为（7.12±1.35）?mmol/?L、（9.03±2.66）?mmol/L、（26.32±1.60）kg/m²，均低于对照组的（7.83± 1.19）?mmol/L、（10.57±2.39）?mmol/?L、（27.74±1.66）kg/m²，差异有统计学意义（t = 3.886、4.241、6.066，P均?< 0.05）。两组患者治疗后HOMA-β较治疗前升高，HOMA-IR较治疗前下降，研究组治疗后HOMA-β为155.69±24.55，高于对照组的117.49±21.98，其HOMA-IR为2.30±0.71，低于后者的3.20±0.64，差异有统计学意义（t = 11.407、9.273，P均< 0.05）。两组患者治疗后VFL、脂肪率均较治疗前下降，研究组治疗后VFL、脂肪率低于对照组，且其治疗后肌肉含量较治疗前下降，差异有统计学意义（P < 0.05）。 结论在二甲双胍的基础上联合利拉鲁肽能够通过改善胰岛β细胞功能、减少内脏脂肪，达到改善T2DM合并肥胖患者的胰岛素抵抗的目的，是一种安全、有效的治疗方案。

Effects of liraglutide combined with metformin on islet beta cell function and visceral fat level in type 2 diabetes mellitus patients with obesity

ObjectiveTo analyze the effects of liraglutide combined with metformin on islet beta cell function and visceral fat level in type 2 diabetes mellitus (T2DM) patients with obesity. Methods194 patients with T2DM and obesity admitted to our hospital from March 2015 to March 2018 were randomly divided into a study group and a control group (97 cases in each group) . All patients were treated with metformin for 16 weeks. The study group was treated with liraglutide subcutaneously. The changes of blood sugar, pancreatic beta cell function index (HOMA-β) and visceral fat level (VFL) before and after treatment were compared between the two groups, and the clinical value of liraglutide in the treatment of T2DM with obesity was summarized. Chi-square test was used for counting data and t-test was used for measuring data. ResultsThe incidence of adverse reactions was 29.90﹪ in the study group and 23.71﹪ in the control group. There was no significant difference between the two groups (χ²= 0.946, P > 0.05) . After treatment, FPG, 2 hPG and BMI of the two groups were all lower than those before treatment, and FPG, 2hPG and BMI in the study group were (7.12±1.35) mmol/L, (9.03±2.66) mmol/L, (26.32±1.60) kg/m², respectively, which were lower than those in the control group (7.83±1.19) mmol/L, (10.57±2.39) ?mmol/?L, (27.74±1.66) ?kg/m², (t = 3.886, 4.241, 6.066, P all < 0.05) . After treatment, HOMA-beta was increased and HOMA-IR was decreased in both groups. After treatment, HOMA-beta in the study group (155.69±24.55) was, higher than that in the control group (117.49±21.98) , and its HOMA-IR (2.30±0.71) was lower than that in the latter group (3.20±0.64) . The difference was statistically significant (t = 11.407, 9.273, P all < 0.05) . The VFL and fat rate of the two groups after treatment were lower than those before treatment. The VFL and fat rate of the study group after treatment were lower than those of the control group, and the muscle content after treatment was lower than that before treatment (P < 0.05) . ConclusionCombination of liraglutide with metformin can improve insulin resistance in patients with T2DM and obesity by improving the function of islet beta cells and reducing visceral fat, which is a safe and effective treatment.