恩格列净对新确诊的超重或肥胖的2型糖尿病患者代谢指标的影响

Effect of empagliflozin on related metabolic indexes in newly diagnosed overweight or obese patients with type 2 diabetes mellitus

目的探讨恩格列净治疗新确诊的超重或肥胖的2型糖尿病患者的疗效,并研究其对内脏脂肪面积(VFA)、β-抑制蛋白2水平及其他相关代谢指标的影响。方法选取2018年10月—2020年3月于成都市第一人民医院内分泌代谢科门诊就诊并新确诊的90例超重或肥胖的2型糖尿病患者,分为恩格列净组和对照组,每组各45例。对照组给予二甲双胍单药治疗,恩格列净组给予二甲双胍与恩格列净联合治疗。治疗12周后,比较两组患者的BMI、腰围(WC)、血压、血糖、血脂、血尿酸、空腹胰岛素(FINS)、VFA、β-抑制蛋白2水平,以及估算的肾小球滤过率(eGFR)、稳态模型胰岛素抵抗指数(HOMA-IR)和稳态模型β细胞功能指数(HOMA-β)。分析β-抑制蛋白2水平的影响因素。结果治疗12周后,两组患者的FBG、FINS和餐后2 h血糖(2 h-PPG)水平、HbA_(1C)、HOMA-IR、TG、WC、BMI均较同组治疗前显著降低或减少(P值均<0.05),HOMA-β均同组较治疗前显著增加(P<0.05)。恩格列净组收缩压、舒张压、血尿酸水平和VFA均较治疗前显著降低或减少,eGFR和β-抑制蛋白2水平均较治疗前显著增高(P值均<0.05),且上述指标治疗前后的变化差值显著均大于对照组(P值均<0.01)。Pearson相关分析结果显示,血清β-抑制蛋白2水平与BMI、VFA、FINS、TG、HOMA-IR、HOMA-β均呈负相关(r=-1.061、-3.136、-2.944、-2.014、-2.113、-3.042,P<0.05或0.01)。多元逐步回归分析结果显示,VFA是β-抑制蛋白2水平的独立影响因素(OR为1.078,95%CI为1.022~1.134)。结论恩格列净治疗可减少超重或肥胖的2型糖尿病患者的VFA,升高β-抑制蛋白2水平,改善患者胰岛素抵抗,临床疗效显著。

Objective To investigate the efficacy of empagliflozin in the treatment of newly diagnosed overweight or obese type 2 diabetes mellitus,and to study its effects on visceral fat area(VFA),β-inhibitory protein 2 and other related metabolic indexes.Methods Ninety overweight or obese outpatients with type 2 diabetes who were treated in the First People’s Hospital of Chengdu from October 2018 to March 2020 were selected as research subjects and randomly divided into empagliflozin group and control group with 45 cases in each group.The control group was treated with metformin,and the empagliflozin group was treated with empagliflozin on the basis of metformin.After 12 weeks of treatment,the body mass index(BMI),waist circumference(WC),blood pressure,blood glucose,blood lipid,uric acid(UA),fasting insulin(FINS),VFA andβ-inhibitory protein 2 levels of the two groups were compared,and the estimated glomerular filtration rate(eGFR),homeostasis model insulin resistance index(HOMA-IR)and homeostasis modelβ-cell function index(HOMA-β)were also compared.The related factors affecting the level ofβ-inhibitor 2 were analyzed.Results In both groups,fasting blood glucose(FBG),2-hour post-prandial glucose(2 h-PPG),glycosylated hemoglobin(HbA_(1C)),HOMA-IR,triglyceride(TG),WC and BMI after treatment were significantly lower than those before treatment(all P<0.05),while the levels of HOMA-βafter treatment were significantly higher than those before treatment(all P<0.05).In empagliflozin group,systolic pressure,diastolic pressure,UA and VFA were significantly lower than those before treatment,while eGFR andβ-inhibitory protein 2 were significantly higher than those before treatment(all P<0.05).The differences of the above indexes before and after treatment in the empagliflozin group were significantly greater than those in the control group(all P<0.01).Serumβ-inhibitory protein 2 level was negatively correlated with BMI,VFA,FINS,TG,HOMA-IR and HOMA-β(r=-1.061,-3.136,-2.944,-2.014,-2.113,-3.042,P<0.05 or 0.01).Multiple stepwise regression analysis showed that VFA was an independent factor influencing the level ofβ-inhibitor protein 2(OR=1.078,95%CI:1.022-1.134).Conclusion Empagliflozin can reduce VFA,increaseβ-inhibitory protein 2 level,and improve insulin resistance in the treatment of overweight and obese type 2 diabetes mellitus.