超重肥胖2型糖尿病合并冠心病患者应用GLP-1RA治疗的效果研究

Effects of GLP-1RA therapy in patients with overweight, obese type 2 diabetes mellitus and coronary heart disease

目的 探讨胰高糖素样肽-1受体激动剂(glucagon-like peptide-1 receptor agonist,GLP-1RA)对超重肥胖的2型糖尿病(diabetes mellitus type 2,T2DM)合并冠心病患者代谢、胰岛素敏感性及心血管获益的影响。方法 将2020年12月至2022年3月,郑州市第七人民医院收治的115例超重肥胖的T2DM合并冠心病患者分为对照组57例,给予常规降糖药物治疗;研究组58例,在对照组基础上增加GLP-1RA治疗。观察两组治疗后的代谢指标、胰岛素敏感性、心功能、再发心血管风险。结果 治疗后,研究组体重指数(t=4.940,P <0.001)、腰围(t=3.840,P <0.001)、体脂含量(t=2.197,P=0.030)及内脏脂肪含量(t=2.143,P=0.034)均低于对照组;研究组胰岛素抵抗指数、C肽曲线下面积均较对照组低,但胰岛素功能高于对照组;另外,研究组N末端B型利钠肽原、颈动脉内膜-中层厚度水平均较对照组低,左室射血分数、心率水平较对照组高;研究组再发心血管风险也低于对照组(3.45%vs. 15.79%,P=0.024)。结论 GLP-1RA可能通过调节超重肥胖的T2DM合并冠心病患者代谢水平,改善胰岛素敏感性,提高心功能,降低再发心血管风险。

Objective To investigate the effects of glucagon-like peptide-1 receptor agonist(GLP-1RA) on metabolism, insulin sensitivity and cardiovascular benefits in patients with overweight and obese type 2 diabetes mellitus(T2DM) and coronary heart disease. Methods From December 2020 to March 2022, 115 patients with overweight or obese T2DM complicated with coronary heart disease admitted to the Department of Cardiology of the Seventh People’s Hospital of Zhengzhou were divided into a control group of 57 cases, treated with conventional hypoglycemic drugs and a study group of 58 patients added GLP-1RA treatment on the basis of the control group. The metabolic indexes, insulin sensitivity, cardiac function, and cardiovascular risk of recurrence were observed in both groups. Results A?ter treatment, the body mass index(t=4.940, P<0.001), waist circumference(t=3.840, P<0.001), body fat content(t=2.197, P=0.030)and visceral fat content(t=2.143, P=0.034) were lower in the study group than those in the control group. The insulin resistance index and area under the C-peptide curve in the study group were lower than those in the control group, but the insulin function was higher than that in the control group. In addition, the N-terminal B-type natriuretic peptide and carotid intimalmiddle thickness levels in the study group were lower than those in the control group, and the le?t ventricular ejection fraction and heart rate levels were higher than those in the control group. The risk of recurrent cardiovascular disease in the study group was also lower than that in the control group(3.45% vs. 15.79%, P=0.024). Conclusion GLP-1RA may improve insulin sensitivity,cardiac function and reduce the risk of recurrence of cardiovascular disease by regulating the metabolic level of overweight and obese patients with T2DM and coronary heart disease.