低碳水化合物饮食结合利拉鲁肽治疗2型糖尿病合并肥胖症的临床疗效

The clinical observation on low-carbohydrate diet combined with liraglutide in type 2 diabetes mellitus patients with obesity

目的探讨低碳水化合物饮食结合利拉鲁肽治疗2型糖尿病合并肥胖症的临床疗效。方法将入组的60例2型糖尿病合并肥胖症患者随机分为2组，A组给予低碳水化合物饮食＋利拉鲁肽干预治疗；B组给予低碳水化合物饮食，比较治疗后两组患者的体重、体重指数（BMI）、腰围、血脂（TC、TG、LDL、HDL）、脂肪率、内脏脂肪、空腹血糖（FBG）、餐后2小时血糖（2hPBG）、糖化血红蛋白（HbA1c）、空腹胰岛素（FINS）、胰岛素抵抗指数（HOMA—IR）等指标的变化情况。结果A组治疗后体重降至（79．00±11．95）kg，腰围降至（97．48±10．78）cm，BMI降至（27．72±3．10）kg／m2，TC、TG、LDL分别降至[（4．42±0．86）、（1．57±0．54）、（3．12±0．61）mmol／L]，FBG、2hPBG分别为[（5．42±0．86）、（7．26±0．84）mmol／L]，HbA1c降至（5．93±0．63）％，FINS为（13．72±4．20）μIU／ml；B组治疗后体重降至（81．04±8．78）kg，腰围降至（99．32±8．08）cm，BMI降至（28．84±2．35）kg／m2，TC、TG、LDL分别降至[（4．74±0．72）、（1．72±1．09）、（3．25±0．84）mmol／L]，FBG、2hPBG分别为[（5．84±0．79）、（7．99±1．04）mmol／L]，HbA1c降至（6．11±0．87）％，FINS为（15．71±3．27）μIU/ml，A、B组两组治疗后比较，体重、BMI、腰围、TC、TG、LDL、脂肪率、内脏脂肪FBC、2hPBG、HbA1c、FINS、HOMA—IR比较差异有统计学意义（P〈0．05），但HDL干预后改善不显著（P〉0．05）。结论低碳水化合物饮食结合利拉鲁肽可明显降低患者体重，改善肥胖相关指标、降低血糖、改善胰岛素抵抗，且效果优于单纯低碳水化合物饮食。

Objective To discuss the clinical curative effect of low-carbohydrate diet combined with liraglutide in type 2 diabetes mellitus patients with obesity. Methods 60 type 2 diabetes mellitus patients with obesity were randomly divided into two groups. Group A was given low-carbohydrate diet combined with liraglutide, and group B was given low-carbohydrate diet. Compared the changes of body weight （BW）, body mass index （BMI）, waist circumference, blood lipid （TC, TG, LDL, HDL）, visceral fat, the fat rate, fasting blood glucose （FBG）, postprandial 2 hours blood glucose （2hPBG）, glycosylated hemoglobin （HbA1c）, fasting insulin （FINS）, insulin resistance index （HOMA-IR） of the two groups after treatment. Results After treatment, the body weight in group A reduced to （79.00± 11.95）kg, the waist circumference reduced to （97.48± 10.78）cm, BMI reduced to （27.72±3.10） kg/m2, TC, TG, LDL reduced to （4.42±0.86） mmol/L, （1.57±0.54） mmol/L, （3.12±0.61） mmol/L respectively, FBG, 2hPBG reduced to （5.42±0.86） mmol/L, （7.26±0.84） mmol/L respectively, HbA1c reduced to （5.93±0.63）%, FINS reduced to （13.72±4.20） μ IU/ml; the body weight in group B reduced to （81.04±8.78）kg, the waist circumference reduced to （99.32±8.08）cm, BMI reduced to （28.84±2.35） kg/m2, TC, TG, LDL reduced to （4.74±0.72） mmol/L, （1.72±1.09） mmol/L, （3.25±0.84） mmol/L respectively, FBG, 2hPBG reduced to （5.84±0.79） mmol/L, （7.99±1.04） mmol/L respectively, HbA1c reduced to （6.11±0.87）%, FINS reduced to （15.71±3.27） μ IU/ml; there were statistically significant differences in body weight, BMI, waist circumference, TC, TG, LDL, visceral fat, the fat rate, FBG, 2hPBG, HbA1c, FINS, HOMA-IR between the two groups after treatment （P〈0.05）, but HDL did not significantly improve after the intervention （P〉0.05）. Conclusion Low-carbohydrate diet combined with liraglutide can significantly reduce body weight, improve obesity related indicators, reduce blood glucose, improve insulin resistance, and the effect is better than that of low-carbohydrate diet only.