利拉鲁肽对肥胖2型糖尿病患者血清Klotho蛋白、分泌型卷曲相关蛋白5及脂肪细胞因子水平的影响

Effect of Liraglutide on Serum Klotho,SFRP5 and Adipocytokines Levels in Patients with Obese Type 2 Diabetes

目的:探讨利拉鲁肽对肥胖2型糖尿病患者血清Klotho(KL)、分泌型卷曲相关蛋白5(SFRP5)及脂肪细胞因子水平的影响。方法:选取2017年1月至2019年1月天门市第一人民医院收治的肥胖2型糖尿病患者86例,采取随机数字表法分为A组(n=43)和B组(n=43)。A组患者口服二甲双胍,B组患者皮下注射利拉鲁肽,两组患者均连续治疗16周。观察两组患者的临床疗效及不良反应发生情况,治疗前后体重指数(BMI)、糖化血红蛋白(HbA1c)、空腹血糖(FBG)、胰高血糖素、腹内脂肪面积(VA)、血清KL、SFRP5、炎症因子[白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)]及脂肪细胞因子(脂联素、瘦素)水平。结果:B组患者的总有效率为93.02%(40/43),明显高于A组的76.74%(33/43),差异有统计学意义(P<0.05)。治疗16周后,两组患者BMI、HbA1c、FBG及胰高血糖素水平均较治疗前明显降低,且B组患者较A组降低更加显著,差异均有统计学意义(P<0.05)。治疗16周后,两组患者VA、IL-6、TNF-α及瘦素水平均较治疗前明显降低,且B组患者IL-6、TNF-α及瘦素水平较A组降低更加显著,差异均有统计学意义(P<0.05),两组患者VA比较的差异无统计学意义(P>0.05);两组患者脂联素水平均较治疗前明显升高,且B组患者较A组升高更加显著,差异均有统计学意义(P<0.05)。治疗16周后,两组患者血清KL、SFRP5水平均较治疗前明显升高,且B组患者血清KL、SFRP5水平较A组升高更加显著,差异均有统计学意义(P<0.05)。治疗期间,B组患者的不良反应发生率为11.63%(5/43),明显低于A组的34.88%(15/43),差异有统计学意义(χ2=6.52,P=0.01)。结论:利拉鲁肽能够通过抑制胰高血糖素水平达到降血糖的目的,且治疗效果较二甲双胍更显著;利拉鲁肽能够减少肥胖2型糖尿病患者腹部脂肪含量及BMI,调节机体脂肪因子及KL、SFRP5的表达水平。

OBJECTIVE:To probe into the effect of liraglutide on serum Klotho(KL),secreted frizzled-related protein-5(SFRP5)and adipocytokines in patients with obese type 2 diabetes.METHODS:Totally 86 patients with obese type 2 diabetes admitted into the First People’s Hospital of Tianmen from Jan.2017 to Jan.2019 were selected and divided into group A(43 cases)and group B(43 cases)via random number table.Group A was given metformin orally,group B was given subcutaneous injection of liraglutide,both groups were treated continuously for 16 weeks.The clinical efficacy and incidences of adverse drug reactions of two groups,the body mass index(BMI),glycosylated hemoglobin(HbA1c),fasting blood-glucose(FBG),glucagon,abdominal fat area(VA),serum KL,SERP5,inflammatory factors[interleukin-6(IL-6),tumor necrosis factorα(TNF-α)]and adipocytokines(adiponectin,leptin)levels before and after treatment were observed.RESULTS:The total effective rate of group B was 93.02%(40/43),which was significantly higher than that of group A(76.74%,33/43),with statistically significant difference(P<0.05).After16-week treatment,the BMI,HbA1c,FBG and glucagon levels of both groups had been significantly decreased,and those of group B were significantly lower than group A,with statistically significant differences(P<0.05).After 16-week treatment,the VA,IL-6,TNF-αand leptin levels of both groups had been significantly decreased,the IL-6,TNF-αand leptin levels of group B were significantly lower than those of group A,with statistically significant differences(P<0.05),there was no statistical significance in difference in VA levels between two groups(P>0.05);the adiponectin levels of both groups had been significantly increased,and that of group B was significantly higher than group A,with statistically significant differences(P<0.05).After 16-week treatment,the serum KL and SFRP5 levels of both groups had been significantly increased,and those of group B were significantly higher than group A,with statistically significant differences(P<0.05).During treatment,the incidence of adverse drug reactions of group B was11.63%(5/43),which was significantly lower than that of group A(34.88%,15/43),with statistically significant difference(χ2=6.52,P=0.01).CONCLUSIONS:Liraglutide can achieve the purpose of lowering blood glucose by inhibiting the glucagon level,which has more significant effect than that of metformin.Liraglutide can reduce the abdominal fat content and BMI of obese type 2 diabetes patients,regulate body adipocytokines and expression levels of KL and SFRP5.