肠促胰素类降糖药对2型糖尿病患者脂代谢的影响及其作用机制

Effects of incretin class of antidiabetic drugs on lipid metabolism in patients with type 2 diabetes and its mechanism

慢性高血糖常伴有脂代谢异常、高血压、轻度全身炎症反应和氧化应激，这些因素共同增加了2型糖尿病患者心血管疾病（CVD）风险。所以，2型糖尿病综合治疗除了实现血糖控制，还应注重改善瞻代谢异常、避免体重增加、降低CVD风险。肠促胰素类药物作为新型降糖药在改善糖、脂代谢从而降低心血管风险方面更有优势。其在改善血糖的同时，可能通过直接影响肝脏脂质代谢，改变脂肪动员及延缓胃排空等不同作用机制对三酰甘油、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇等主要脂质代谢指标产生积极影响。可能在2型糖尿病的综合管理中发挥重要作用。

Chronic hyperglycemia is often accompanied by abnormal lipid metabolism, hypertension, low- grade systemic inflammation and oxidative stress. These factors increase the risk of cardiovascular disease （CVD） in type 2 diabetes mellitus （T2DM） patients. Comprehensive treatment of T2DM should emphasize the improvement of abnormal lipid metabolism, prevention of weight gain and reduction of the CVD risk in addition to proper glycemic control. Incretin, as a new hypoglycemic drug, has more advantages in improving glucose and lipid metabolism, finally to reduce cardiovascular risk. Through possible mechanisms including direct influence on liver lipid metabolism, change of fat mobilization and delay of gastric emptying, incretin shows positive influence on the lipid metabolic markers such as low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol, triglycerides, and total cholesterol, while it improves glucose control. Thus, incretin plays an important role in the comprehensive management of type 2 diabetes mellitus.