利拉鲁肽对老年2型糖尿病肥胖患者血清趋化素、血清成纤维细胞生长因子-21及内脂素水平影响分析

Analysis of the effect of Liraglutide on serum chemerin, FGF-21 and visfatin in elderly obese patients with type 2 diabetes mellitus

目的分析利拉鲁肽对老年2型糖尿病(type 2 diabetes mellitus,T2DM)肥胖患者血清趋化素、血清成纤维细胞生长因子-21(serum fibroblast growth factor-21,FGF-21)及内脂素水平的影响。方法选取2016年4月至2017年5月本院收治的84例口服降糖药治疗效果不佳的老年T2DM肥胖患者纳入治疗组,同时选取年龄匹配的健康志愿者及单纯T2DM患者各84例分别纳入对照组和单纯T2DM组,记录三组研究对象治疗前及治疗组患者采用利拉鲁肽治疗20周后体重、血压、腰围、臀围等指标,计算体质指数(body mass index,BMI)、腰臀比、血清趋化素、FGF-21、内脂素水平变化,分析血清趋化素、FGF-21、内脂素水平与代谢指标之间的相关性。结果治疗组患者治疗前体重、腰围、臀围、BMI、腰臀比、空腹血糖(fasting plasma glucose,FPG)、收缩压、舒张压、糖化血红蛋白(glycated hemoglobin A1c,Hb A1c)、胰岛素抵抗指数(Homeostasis model assessment insulin resistance index,HOMA-IR)、甘油三酯(triglyceride,TG)、总胆固醇(total cholesterol,TC)、低密度脂蛋白胆固醇(low density lipoprotein-cholesterol,LDL-C)、血清趋化素、FGF-21及内脂素水平均显著高于对照组和单纯T2DM组(P<0.05),胰岛β细胞功能(Homeostasis model assessment-IR-β,HOMA-β)和高密度脂蛋白胆固醇(high density lipoprotein-cholesterol,HDL-C)水平均显著低于对照组和单纯T2DM组(P<0.05)。治疗组患者治疗后体重、BMI、腰围、腰臀比、FPG、SBP、DBP、Hb A1c、HOMA-IR、TC、LDL-C、TG、血清趋化素、内脂素及FGF-21水平均显著低于治疗前(P<0.05),HOMA-β和HDL-C水平均显著高于治疗前(P<0.05),治疗前后臀围变化不明显(P>0.05)。治疗组患者血清趋化素、FGF-21、内脂素水平与、FPG、Hb A1c、HOMA-IR及TG水平均呈正相关(P<0.05)。HOMA-IR和TG为影响血清趋化素、FGF-21、内脂素的独立危险因素。结论利拉鲁肽能够降低老年T2DM肥胖患者血清趋化素、FGF-21及内脂素水平,有效控制血糖水平,改善肥胖患者内脏脂肪堆积。

Objective To explore the effect of Liraglutide on serum chemerin,fibroblast growth factor-21(FGF-21)and visfatin in elderly obese patients with type 2 diabetes mellitus(T2DM).Method 84 cases of elderly obese patients with T2DM in our hospital from April 2016 to May 2017 were selected as treatment group,healthy volunteers and simple T2DM patients were selected during the same time as control group and simple T2DM group,84 cases in each group.The body weight,blood pressure,waist circumference,hip circumference and other indicators of the three groups were recorded before and after 20 weeks of treatment.Body mass index(BMI),waist hip ratio,serum chemokine,FGF-21 and visfatin levels were calculated.The correlation between serum chemerin,FGF-21,visfatin levels and metabolic markers were analyzed.Result Before treatment,weight,waist circumference,hip circumference,waist hip ratio,BMI,systolic fasting plasma glucose(FPG),pressure,diastolic pressure,glycated hemoglobin A1c(HbA1c),Homeostasis model assessment insulin resistance index(HOMA-IR),triglyceride(TG),total cholesterol(TC),low density lipoprotein-cholesterol(LDL-C),serum chemerin,FGF-21 and visfatin of treatment group were higher than that in control group and simple T2DM group(P<0.05),Homeostasis model assessment-β(HOMA-β),high density lipoprotein-cholesterol(HDL-C)levels were lower than that in control group and simple T2DM group(P<0.05).After treatment,the weight,BMI,waist circumference,waist hip ratio,FPG,SBP,DBP,HbA1c,HOMA-IR,TC,LDL-C,TG,serum chemerin,visfatin and FGF-21 of the treatment group were significantly lower than before(P<0.05),HOMA-βand HDL-C levels were significantly higher than before(P<0.05).The hip circumference was not significantly changed before and after treatment(P>0.05).The levels of serum chemerin,FGF-21 and visfatin of treatment group patients were positively correlated with the levels of FPG,HbA1c,HOMA-IR and TG(P<0.05).HOMA-IR and TG were the independent risk factors of serum chemerin,FGF-21 and visfatin.Conclusion The level of serum chemerin,FGF-21 and visfatin in elderly obese patients with T2DM can be reduced,and the level of blood glucose can be effectively controlled and the visceral fat accumulation in obese patients can be improved.