二甲双胍联合利拉鲁肽对2型糖尿病患者胰岛α和β细胞、细胞因子及细胞免疫功能的影响

Effects of Metformin Combined with Liraglutide on Islet αandβ Cells, Cytokines and CellularImmune Function in Patients with T2DM

[目的]探讨二甲双胍联合利拉鲁肽对2型糖尿病（T2DM）患者胰岛a和B细胞、细胞因子及细胞免疫功能的影响。【方法】选择2016年4月至2017年4月本院诊治的T2DM患者102例，按照随机表法分为观察组和对照组，每组51倒。观察组采用二甲双胍联合利拉鲁肽治疗，对照组仅采用二甲双胍治疗。两组疗程均为12周。比较两组治疗前后空腹血糖（FPG）、餐后2h血糖（2hPO）、糖化血红蛋白（HbAlc）、胰岛素抵抗指数（HOMA-IR）、胰岛B细胞功能指数（HOMA／3）、空腹胰高血糖素（FGlg）、白介素6（II，6）、胰岛素生长因子-1（IGF-1）、肿瘤坏死因子-a（TNF-d）、CD3＋、CD4＋和CD4＋／CD8＋变化。【结果】两组治疗后FPG、2hPG和HbAlc均较治疗前下降（P〈O．05）；观察组治疗后FPG、2hPG和HbAlc低于对照组（P〈0．05）。两组治疗后HOMA-IR和FGlg降低而HOMA／增加（P〈0．05）；观察组治疗后HOMAIR和FGlg低于对照组而HOMA-a高于对照组（P〈0．05）。两组治疗后1L-6、1GF-1、TNF-a水平降低（P〈0．05）；观察组治疗后IL-6、IGF-1、TNP-a水平低于对照组（P〈0．05）。两组治疗后CD3＋、CD4＋和CD4＋／CD8＋增加（P〈O．05）；观察组治疗后CD3＋、CD4＋和CD4＋／CD8＋高于对照纽（f=10．8227、5．9040、7．1660，P〈0．05）。两纽不良反应发生率比较差异无统计学意义（P〉0．05）。【结论】二甲双胍联合利拉鲁肽治疗T2DM患者疗效显著，改善患者胰岛d和B细胞、细胞因子及细胞免疫功能，值得临床推广应用。

[Obiective] To investigate the effects of metformin combined with liraglutide on islet a and cells, cytokines and cellular immune function in patients with type 2 diabetes mellitus （T2DM）.[Methods] From April 201（; to April 2017, 102 patients wilh T2DM were selected. According to the random table meth od, the patients were divided into observation group and control group with 51 cases in each group. The obser- vation group was treated with metformin and liraglutide, the control group was treated only by metformin. The course of treatment was 12 weeks in both groups. Before and after treatment, the changes of FPG,2hPG, HbAlc, HOMA-IR, HOMA-l, fasting glucagon（FGlg）, II.6, IGF-1, TNF＋, CD3＋ and CD4＋ CD4＋/ CD8＋ were compared between the two groups. [Results] After treatment, FPG, 2h PG and HbAlc in both groups were significantly lower than those before treatment （ P 〈0.05）. After treatment, HOMIR and FGlg decreased and HOMA-aincreased in both groups （ P〈0.05）. After treatment, HOMA IR and FGlg in the observation group were lower than those in the control group, but HOMA- 1 was higher than that in the control group （ P %0.05）. After treatment, the level of IL-6, IGF-1,TNF adecreased in both groups （ P 〉0.05）. The level of IL-6, IGF-1 and TNF-in the observation group was lower than that of the control group （ P 〈0.05）. CD＋ and CD4/CD8 of CD8 were increased in both groups after treatment （ P %0.05）. The levels of CD3＋ , CD4＋ and CD4＋/CD84 in the observation group were higher than those in the control group （ t = 10.8227,5.9040,7.1660, P〈0.05）. There was no significant difference in the incidence of adverse reactions between the two groups （ P 〉0.05）.[Conclusion] The curative effect of metformin combined with Lilaru pep-tide on T2DM patients is significant. It can improve the islets alpha and beta cells, cytokines and cellular im- mune functions of the patients,and is worthy of clinical application.