艾塞那肽对2型糖尿病患者疗效、体重及体质成分的影响

Effect of Exenatide on Plasma Glucose, Weight and Body Fat in Poorly Controlled Type 2 Diabetes Patients Using Oral Antidiabetic Drug

目的:应用艾塞那肽治疗口服药物血糖控制不佳的2型糖尿病患者,评价其降糖疗效、对体重及全身各部位体质成分的影响。方法:选取2011年2月-2012年6月本收治的15例口服药物血糖控制不佳的2型糖尿病患者,在原有口服降糖药基础上,联用艾塞那肽皮下注射3个月,用药前后分别通过人体成分分析仪测定体重、体重指数、体脂百分数、腰臀脂肪比率及内脏脂肪区域,通过双能X线骨密度仪测定上肢、下肢、躯干及全身脂肪量及脂肪百分比、肌肉及骨矿物盐含量,并进行统计。结果:经过3个月的治疗,患者HbA1c有所下降,与治疗前比较差异有统计学意义(t=3.472,P<0.01);腰围、臀围及腰臀比有所下降,但差异无统计学意义(P>0.05);治疗后体重、体重指数、体脂百分比及内脏脂肪区域均明显下降,与治疗前比较差异均有统计学意义(t体重=4.424,P<0.01;t体重指数=4.337,P<0.01;t体脂百分比=4.426,P<0.01;t内脏脂肪区域=4.025,P<0.01);腰臀脂肪比率有所下降,但差异无统计学意义(P>0.05);治疗后下肢、躯干、全身脂肪量较治疗前均明显下降,差异有统计学意义(t下肢脂肪量=4.008,P<0.01;t躯干脂肪量=2.914,P<0.05;t全身脂肪量=3.474,P<0.01);下肢、躯干、全身脂肪百分比较治疗前明显下降,差异有统计学意义(t下肢脂肪百分比=2.405,P<0.05;t躯干脂肪百分比=2.756,P<0.05;t全身脂肪百分比=2.281,P<0.05);上肢脂肪量及脂肪百分比有所下降,但差异无统计学意义(P>0.05);治疗前后上肢、下肢、躯干、全身肌肉及骨矿物盐含量无明显改变;治疗后体重下降幅度与躯干和全身脂肪量下降幅度高度相关(r=0.860、0.819,P<0.01);治疗后全身脂肪量下降幅度与下肢和躯干脂肪量下降幅度高度相关(r=0.834、0.955,P<0.01)。结论:口服药控制不佳的2型糖尿病加用艾塞那肽治疗,在有效地控制血糖的同时,可减轻体重,减重以脂肪量减少为主,主要减少下肢、躯干脂肪,对肌肉和骨矿物盐含量无影响。

Objective： To evaluate the effect of exenatide on plasma glucose, weight and body fat in poorly controlled type 2 diabetes patients using oral antidiabetic drug.Method： 15 cases of poorly controlled type 2 diabetes who used oral antidiabetie drug in our hospital were selected. Exenatide was injected subcutaneously together with the original basis of oral hypoglycemie agents for three months, and the body weight, body mass index （ BMI ）, the percentage of body fat tissue, the percentage of fat tissue of waist to hip and visceral fat range were analyzed by body composition analyzer before and after treatment. In the mean time, Dual-energy X-ray absorptiometry was used to determine the fat mass and percentage, muscle and bone mineral salts mass of upper limb, Lower limb, trunk, and whole body. Result： After 3 months＇ treatment, HbA lc were significantly decreased than before, had statistical differences （ t=3.472, P〈0.01 ）. The waistline, the hip circumference and the waist-hip ratio （ WHR ） were decreased than before, but no statistical difference （ P〉0.05 ） . The body weight, BM, the percentage of body fat and visceral fat range were significantly decreased before and after treatment （ t--4.424, P〈0.0I ; t=4.337, P〈0.01 ; t=4.426, P〈0.01 ; t--4.025, P〈0.01 ） . The fat tissue of waist-hip ratio was decreased than before, but no statistical difference （ P〉0.05 ） . After 3 months＇ treatment, the fat tissue mass of lower limb, trunk, and whole body were significantly decreased than before, had statistical differences （t=4.008, P〈0.01; t= 2.914, P〈0.05; t= 3.474, P〈0.01 ） . After 3 months＇ treatment, the fat tissue mass percentage of lower limb, trunk, and whole.body were significantly decreased, had statistical differences （ t=2.405, P〈0.05; t=2.756, P〈0.05; t=2.281, P〈0.05 ） . The fat tissue mass and percentage of upper limb was decreased than before, but no statistical difference （ P〉0.05 ） . The muscle and bone mineral salts mass were not altered （ P〉0.05 ） . After 3 months＇ treatment, the decrease of body weight was highly correlated with the decrease of trunk fat and whole body fat （ r=- 0.860, 0.819, P〈0.01 ） . The decrease of whole body fat was highly correlated with lower limb fat and trunk fat （ r=0.834, 0.955, P〈0.01 ） .Conclusion： Exenatide can effectively control the level of plasma glucose of patients which being poorly controlled by oral antidiabetic drug, decrease the body weight which depends on fat mass decrease, especially lower limb, trunk fat. Exenatide don＇t affected on muscle and bone mineral salts mass.