艾塞那肽联合二甲双胍对2型糖尿病伴肥胖患者的干预效果

The intervention effect of exenatide combined with metformin in patients with type 2 diabetes mellitus complicated by obesity

目的 探讨艾塞那肽联合二甲双胍对2型糖尿病（T2DM）伴肥胖患者的干预效果.方法 选取本院2012年1月至2015年1月期间收治的T2DM伴肥胖患者78例,以随机数表法分为观察组和对照组,每组各39例.观察组给予艾塞那肽联合盐酸二甲双胍治疗,对照组给予盐酸二甲双胍口服治疗,两组治疗周期均为12周;比较治疗前后两组患者体重（BW）、腰围（W）、体重指数（BMI）、血脂总胆固醇（TC）、甘油三酯（TG）、血糖（FBG）、餐后2h血糖（2 hPBG）控制及胰岛素分泌指数（HOMA-％B）、胰岛素抵抗指数（HOMA-R）的变化,并观察和比较两组不良反应和低血糖发生情况.结果 治疗前后,观察组BW、W、BMI、TC、TG、FBG、2hPBG、HOMA-％B、HOMA-R比较差异有统计学意义（P＜0.05）,对照组仅BW、TC、2hPBG、HOMA-R比较差异有统计学意义（P＜0.05）;治疗后与对照组比较,观察组W（96.56±7.22） cm、BMI（25.03±2.33）kg/m、TG（3.09±0.21） mmol/L、FBG（7.09±1.07）mmol/L、2hPBG（10.04±2.12）mmol/L、HOMA-R（3.10±0.77）显著低于对照组（P＜0.05）;HOMA-％B显著高于对照组（P＜0.05）;观察组不良反应为10.26％显著低于对照组的33.33％（P＜0.05）.结论 艾塞那肽联合二甲双胍能有效减低T2DM伴肥胖患者的血糖水平和体重指数,并有效改善血脂代谢,减轻胰岛素抵抗,是一种值得临床推广的安全方案.

Objective To explore the intervention effect of exenatide combined with metformin in patients with type 2 diabetes mellitus （T2DM） complicated by obesity.Methods 78 cases of T2DM complicated by obesity treated in our hospital between January 2012 and January 2015 were selected and divided into observation group and control group according to the random number table method,with 39 cases in each group.Observation group was treated with exenatide combined with metformin hydrochloride,while control group was treated with oral metformin hydrochloride.The treatment cycle of both two groups was 12 weeks.The control of body weight （BW）,waistline （W）,body mass index （BMI）,blood total cholesterol （TC）,triglyceride （TG）,fasting blood glucose （FBG）,and 2 h postprandial blood glucose （2hPBG） and changes of homeostasis model assessment-B （HOMA-%B）,and homeostasis model assessment of insulin resistance （HOMA-R） were compared between two groups before and after treatment.The occurrence of adverse reactions and hypoglycemia were observed and compared between two groups.Results Before and after treatment,there were no statistically significant differences in BW,W,BMI,TC,TG,FBG,2hPBG,and HOMA-R in observation group （P〉0.05）,there were no statistically significant differences in BW,TC,2hPBG,and HOMA-R in control group （P〉0.05）.After treatment,W [（96.56±7.22）cm],BMI [（25.03±2.33）kg/m],TG [（3.09±0.21） mmol/L],FBG [（7.09±1.07） mmol/L],2hPBG [（10.04±2.12） mmol/L],and HOMA-R [（3.10±0.77）] of observation group were significantly lower than those of control group （P〈0.05）,while HOMA-%B [（103.89±3.067）] was significantly higher than that of control group （P〈0.05）.The incidence of adverse reactions and hypoglycemia in observation group （10.26%）was significantly lower than that in control group （33.33%） （P〈0.05）.Conclusion Exenatide combined with metformin can effectively reduce the blood glucose level and body mass index in patients with T2DM complicated by obesity,which can effectively improve lipid metabolism,and reduce insulin resistance,is a safe regimen worthy of clinical promotion.