二甲雙胍聯合沙格列汀或格列美脲對新診斷合并腹型肥胖的2型糖尿病患者臨床療效對比

廖霜

摘 ? 要：目的 ?比較二甲雙胍聯合沙格列汀或者格列美脲在新診斷合并腹型肥胖的2型糖尿病患者療效與安全性。方法 ?選取2017年4月～11月在我院就診新診斷合并腹型肥胖的T2DM患者100例，每組50例。采用隨機數字表法分為實驗組和對照組，實驗組給予二甲雙胍聯合沙格列汀治療，對照組給予以二甲雙胍聯合格列美脲治療。比較兩組FPG、2hPPG、HbA1C、FINS、HOMA-β，評估兩組患者腰圍（WC）、BMI、血壓、血脂改善情況及服藥期間低血糖發生情況。結果 ?91例患者完成治療隨訪，其中對照組45例，實驗組46例。與治療前相比，兩組患者HbA1C、FPG、PPG均降低（P<0.05），但兩組間比較，差異有統計學意義（P>0.05）;與治療前相比，兩組FINS、HOMA-β升高（P<0.05）。與對照組相比，實驗組FINS、HOMA-β有改善（P<0.05）。治療后，患者BMI、SBP、DBP、TG、LDL-C等指標比較，差異有統計學意義（P>0.05）。治療后實驗組WC呈現降低趨勢，而對照組均有不同程度的升高;與對照組比較，實驗組治療后WC降低（P<0.05），治療期間實驗組患者低血糖發生率（4.34%）低于對照組（20.00%）（P<0.05）。兩組均無嚴重不良事件發生。結論 ?對新診斷的合并腹型肥胖的T2DM患者，二甲雙胍聯合沙格列汀與二甲雙胍聯合格列美脲降糖療效相當，但沙格列汀在縮小低腰圍及改善胰島功能方面具有優勢，同時具有較低的低血糖發生率。

關鍵詞：2型糖尿病;腹型肥胖;糖化血紅蛋白;胰島功能;沙格列汀;格列美脲

中圖分類號：R587.1 ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?文獻標識碼：A ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?DOI：10.3969/j.issn.1006-1959.2018.24.018

文章編號：1006-1959（2018）24-0070-04

Abstract：Objective ?To compare the efficacy and safety of metformin combined with salglutin or glimepiride in newly diagnosed type 2 diabetic patients with abdominal obesity.Methods ?A total of 100 T2DM patients with abdominal obesity were selected from April to November 2017 in our hospital，50 patients in each group.And were divided into the experimental group and the control group according to the random digital table.The experimental group was treated with metformin combined with salgletine， and the control group with metformin combined with glimepiride.We Compared the FPG，2hPPG，HbA1C，FINS，HOMA-β of the two groups，and waistline（WC）， BMI， blood pressure， blood lipid improvement and hypoglycemia were evaluated in both groups.Results ?91 cases were followed up， including 45 cases in control group and 46 cases in experimental group.Compared with before treatment， HbA1C，FPG，PPG in both groups was lower than that before treatment （P<0.05）， but there was no significant difference between the two groups（P>0.05）.Compared with before treatment， FINS，HOMA-β increased in both groups （P<0.05）.Compared with the control group， FINS，HOMA-β in the experimental group was improved （P<0.05）. After treatment，the change of BMI，SBP，DBP，TG，LDL-C and other indexes were compared（P>0.05）.After treatment， the WC of the experimental group showed a decreasing trend， while the control group had different degrees of increase. Compared with the control group， the WC of the experimental group decreased after treatment （P<0.05）， and the incidence of hypoglycemia in the experimental group during the treatment period （4.34%）. It was lower than the control group （20.00%） （P<0.05）. There were no serious adverse events in either group. Conclusion ?For newly diagnosed patients with T2DM with abdominal obesity， metformin combined with saxagliptin is equivalent to metformin combined with glimepiride， but saxagliptin has advantages in reducing low waist circumference and improving islet function. Lower incidence of hypoglycemia.

Key words：Type 2 diabetes;Abdominal obesity;Glycosylated hemoglobin;Islet function; Salgletine;Glimepiride

中國糖尿病患病率逐年升高，根據國際糖尿病聯合會IDF發布的《糖尿病地圖》數據顯示，目前中國糖尿病患者人數已超1億，居世界首位[1]。與白種人相比，雖然中國成人糖尿病患者體質指數（BMI）發病切點更低[2]，但合并腹型肥胖比例高達45.4%[3]。過度的內臟脂肪堆積可通過多種途徑促使胰島素抵抗的發生[4]，從而顯著增加2型糖尿病（type 2 diabetes mellitus，T2DM）患者心血管事件發生風險及血糖控制難度[5]。二甲雙胍是治療T2DM最常用的一線口服降糖藥，對新診斷的HbA1C較高的T2DM患者需要起始雙藥聯合治療[6]。本研究對二甲雙胍聯合沙格列汀或者格列美脲在新診斷合并腹型肥胖的T2DM患者療效、安全性進行評價，以探尋對合并腹型肥胖T2DM患者在血糖控制達標前提下即對體重影響小且改善代謝及胰島功能的治療方案。……