艾塞那肽降低2型糖尿病患者体重的预测因素研究

Predictive factors associated with weight response to exenatide in patients with type 2 diabetes mellitus

目的:探讨艾塞那肽降低2型糖尿病(T2DM)患者体重的影响因素,为T2DM患者艾塞那肽精准治疗提供依据。方法:选取2017年1月至2020年12月连续使用艾塞那肽治疗12个月的T2DM患者,测量患者身高、体重,计算体重指数(BMI),检测患者用药前及用药3个月、6个月、12个月的糖化血红蛋白(HbA1c)、空腹血糖(FPG)、餐后血糖(PPG)、空腹胰岛素(FINS)、餐后胰岛素(PINS)、血脂、联合降糖治疗方案等。根据患者体重下降是否超过3%,将使用艾塞那肽治疗患者分为治疗应答组和治疗不应答组,采用二分类Logistic回归分析方法,寻找艾塞那肽降低T2DM患者体重的预测因素。结果:治疗应答组T2DM患者病程明显短于不应答组(P<0.05);与治疗前临床指标相比,治疗应答组及不应答组体重、BMI、HbA1c、FPG、PPG、稳态模型胰岛素抵抗指数(HOMA-IR)均明显下降,而稳态模型胰岛功能(HOMA-B)明显升高(P<0.001);艾塞那肽治疗6个月后,T2DM患者体重下降与基线体重和基线HbA1c密切相关(P<0.05)。结论:基线体重、HbA1c改善与艾塞那肽治疗6个月后体重下降呈正相关关系,是艾塞那肽治疗T2DM患者降低体重的可靠预测因素。

AIM:To explore which variables can predict the weight response to exenatide and to individualize specific therapies for patients with type 2 diabetes mellitus(T2DM)who need treatment with exenatide.METHODS:We performed a study among T2DM patients who were treated with exenatide twice daily for at least 12 months from January 2017 to December 2020.Data of the height,weight,body mass index(BMI)calculated,and HbA1c,fasting plasma glucose(FPG),postprandial plasma glucose(PPG),fasting serum insulin(FINS),postprandial serum insulin(PINS),blood lipids and concurrent diabetic medications at baseline,3 months,6 months and 12 months after exenatide initiation were collected.Patients were categorized into two cohorts based on weight loss≥3%:responders and non-responders.The binary logistic regression analysis was used to identify the major variables of weight response to exenatide.RESULTS:The duration of diabetes in the responder group was shorter than that in patients in the non-responder group(P<0.05).For patients in the responder and non-responder groups,there was a significant decrease in weight,BMI,HbA1c,FPG,PPG,homeostasis model assessment of insulin resistance(HOMA-IR)and increase in homeostasis model assessment for beta cell function(HOMA-B)compared with the prarameters before treatment with exenatide(P<0.001).The baseline weight and baseline HbA1c were associated with weight loss after 6 months of treatment with exenatide(P<0.05).CONCLUSION:Baseline weight and HbA1c improvement were positively correlated with weight loss after 6 months of treatment with exenatide and the major predictors of weight response to exenatide.