西格列汀联合二甲双胍对肥胖型2型糖尿病患者胰岛功能、糖脂代谢指标及脂肪因子的影响

Effects of sitagliptin combined with metformin on islet function, glucose and lipid metabolism and adipokines in obese patients with type 2 diabetes mellitus

目的探讨西格列汀联合二甲双胍对肥胖型2型糖尿病(T2DM)患者胰岛功能、糖脂代谢指标及脂肪因子的影响。方法将2014年1月至2016年5月滕州市中心人民医院收治的94例肥胖型T2DM患者随机分为对照组与观察组,每组47例。对照组采用二甲双胍治疗,观察组在对照组基础上加用西格列汀治疗,两组均持续治疗6个月,测定治疗前后两组患者的体质指数(BMI),血糖、血脂、胰岛素水平及脂肪因子水平的变化,统计两组不良反应发生情况。结果治疗后6个月,两组BMI、腰围、体脂率(FAT)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FPG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)、内脏脂肪素(Vfn)均较治疗前降低(P<0.05);且观察组上述指标均低于对照组(P<0.05)。治疗后6个月,两组高密度脂蛋白胆固醇(HDL-C)、胰岛β细胞指数(HOMA-β)、脂联素(APN)、网膜素-1(Omentin-1)水平均较治疗前升高;且观察组上述指标均高于对照组(P<0.05)。治疗期间,观察组与对照组不良反应发生率(8.51%比6.38%)比较差异未见统计学意义(P>0.05)。结论西格列汀联合二甲双胍可降低肥胖型T2DM患者的血糖、血脂水平,改善胰岛素抵抗,增强胰岛β细胞功能,调节脂肪因子表达。

Objective To investigate the effects of sitagliptin combined with metformin on the islet function, glucose and lipid metabolism and adipokines in obese patients with type 2 diabetes mellitus (T2DM). Methods A total of 94 obese patients with T2DM treated in Tengzhou Central People’s Hospital from January 2014 to May 2016 were randomly divided into control group and observation group, with 47 cases in each group. Patients in control group were treated with metformin, and patients in observation group were treated with sitagliptin and metformin. The two groups were given 6 months of treatment. Body mass index (BMI), levels of blood glucose, blood lipids, insulin and adipokines before and after treatment were determined, and the incidence of adverse reactions was statistically analyzed. Results After 6 months of treatment, BMI, waist circumference, body fat percentage (FAT), total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), fasting plasma glucose (FPG), 2 h postprandial plasma glucose (2 h PG), glycosylated hemoglobin (HbA1c), fasting insulin (FINS), insulin resistance index (HOMA-IR) and visfatin (Vfn) were decreased in the two groups (P<0.05), and the above-mentioned indexes in observation group were lower than those in control group (P<0.05). After 6 months of treatment, levels of high-density lipoprotein cholesterol (HDL-C), pancreatic β cell index (HOMA-beta), adiponectin (APN) and Omentin-1 were increased in the two groups, and the above-mentioned indexes in observation group were higher than those in control group (P<0.05). During the treatment, there was no significant difference in the incidence of adverse reactions between the two groups (8.51% vs. 6.38%), P>0.05. Conclusions Sitagliptin combined with metformin can decrease levels of blood glucose and blood lipid, improve insulin resistance, enhance the function of pancreatic β cells and regulate the expression of adipokines in obese patients with T2DM.