达格列净联合双歧杆菌三联活菌胶囊治疗2型糖尿病患者对糖脂代谢和肠道菌群的影响

Effect of dapagliflozin combined with bifidobacterium triple viable capsule on the glycolipid metabolism and intestinal flora in patients with type 2 diabetes mellitus

目的观察达格列净联合双歧杆菌三联活菌胶囊治疗2型糖尿病(T2DM)患者对糖脂代谢和肠道菌群的影响。方法选择2017年1月—2018年12月武汉大学中南医院内分泌科收治的T2DM患者103例作为研究对象,按随机数字表法分为对照组51例和观察组52例。对照组给予二甲双胍治疗,观察组在对照组治疗的基础上给予达格列净联合双歧杆菌三联活菌胶囊治疗,2组均治疗12周。比较2组治疗前后空腹血糖(FPG)、餐后2h血糖(2hPG)、糖化血红蛋白(HbA1c)、三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、胰岛素抵抗指数(HOMA-IR)和胰岛β细胞功能指数(HOMA-β)及肠道双歧杆菌、革兰阳性杆菌(G+b)、革兰阴性杆菌(G-b)数量变化情况。观察2组患者治疗期间的不良反应。结果观察组治疗后FPG、2hPG、HbA1c、TG、TC、LDL-C水平低于对照组(t/P=10.446/0.000、5.518/0.000、7.501/0.000、4.294/0.000、5.814/0.000、6.101/0.000),HDL-C水平高于对照组(t/P=3.116/0.001),肠道双歧杆菌、G+b及G-b数量多于对照组(t/P=3.294/0.001、5.416/0.000、4.965/0.000);观察组治疗后HOMA-β高于对照组(t/P=5.258/0.000),HOMA-IR低于对照组(t/P=12.563/0.000);2组患者治疗期间均未出现严重的不良反应。结论达格列净联合双歧杆菌三联活菌胶囊治疗T2DM患者,能够改善糖脂代谢功能,缓解胰岛素抵抗,提高胰岛素敏感性,还能够增加肠道双歧杆菌的数量。

Objective To observe the effects of dapagliflozin combined with Bifidobacterium triple viable Capsule on the glycolipid metabolism and intestinal flora in patients with type 2 diabetes mellitus(T2DM).Methods One hundred and three patients with T2DM admitted to the Department of Endocrinology,Zhongnan Hospital,Wuhan University from January 2017 to December 2018 were selected as the study subjects.51 patients in the control group and 52 patients in the observation group were divided into two groups according to the random number table method.The control group was treated with metformin,while the observation group was treated with dapagliflozin combined with Bifidobacterium triple viable Capsule on the basis of the control group.Both groups were treated for 12 weeks.The fasting blood glucose(FPG),postprandial blood glucose(2h PG),glycosylated hemoglobin(HbA 1c),triglyceride(TG),total cholesterol(TC),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),insulin resistance index(HOMA-IR)and islet beta-cell function index were compared between the two groups before and after treatment.Number(HOMA-beta)and changes of intestinal bifidobacterium,Gram-positive bacilli(G+b)and gram-negative bacilli(G-b).Adverse reactions during treatment were observed in both groups.Results After treatment,the levels of FPG,2h PG,HbA 1c,TG,TC and LDL-C in the observation group were lower than those in the control group(t/P=10.446/0.000,5.518/0.000,7.501/0.000,4.294/0.000,5.814/0.000,6.101/0.000),HDL C was higher than those in the control group(t/P=3.116/0.001),and the numbers of intestinal bifidobacteria,G+b and G-b were higher than those in the control group(t/P=3.294/0.00).1,5.416/0.000,4.965/0.000);after treatment,HOMA-beta in the observation group was higher than that in the control group(t/P=5.258/0.000),and HOMA-IR was lower than that in the control group(t/P=12.563/0.000);there were no serious adverse reactions in both groups during treatment.Conclusion Dapagliflozin combined with Bifidobacterium triple viable capsule in the treatment of patients with T2DM can improve glycolipid metabolism,alleviate insulin resistance,improve insulin sensitivity,and increase the number of intestinal bifidobacteria.