奥利司他对超重或肥胖患者内脏脂肪及胰高血糖素样肽-1水平的影响

Effects of orlistat on visceral fat and glucagon-like peptide-1 levels in overweight or obese patients

目的探讨奥利司他对超重或肥胖患者的内脏脂肪及血清胰高血糖素样肽-1(GLP-1)水平的影响。方法选取2020年3月至2022年3月杭州师范大学附属医院代谢病中心就诊的超重或肥胖患者为研究对象,根据随机数字表法分为观察组与对照组。对照组仅生活方式干预治疗,观察组在生活方式干预基础上联合奥利司他胶囊120 mg/次,3次/d,餐时口服,治疗16周后分析两组代谢指标、内脏脂肪面积(VFA)及GLP-1水平的变化。结果最终纳入102例患者,观察组52例,对照组50例。观察16周后,观察组甘油三酯[(1.94±0.82)mmol/L比(2.46±0.74)mmol/L]、VFA[(96.54±15.57)cm^(2)比(102.80±15.70)cm^(2)]、BMI[(25.27±2.24)kg/m^(2)比(26.13±1.96)kg/m^(2)]及腰臀比[(0.89±0.07)比(0.92±0.06)]均较对照组显著下降(P<0.05);GLP-1水平[(5.27±0.76)pmol/L比(3.78±0.73)pmol/L]、胰岛β细胞功能指数[(78.10±11.59)比(72.74±11.63)]、高密度脂蛋白胆固醇[(1.35±0.22)mmol/L比(1.16±0.26)mmol/L]较对照组显著上升(P<0.05);经多元线性逐步回归分析,腰臀比(β=-3.180,P=0.040)、VFA(β=-0.013,P=0.045)和高密度脂蛋白胆固醇(β=0.859,P=0.029)对血清GLP-1水平变化有显著影响。结论奥利司他能改善超重或肥胖患者的血糖、血脂、减少VFA、改善胰岛抵抗,且临床疗效与GLP-1水平升高有密切联系。

Objective To explore the effects of orlistat on visceral fat and glucagon-like peptide-1(GLP-1)levels in overweight or obese patients.Methods From March 2020 to March 2022,overweight or obese patients in the Metabolic Dis⁃ease Center of the Affiliated Hospital of Hangzhou Normal University were selected as the research objects,and were randomly divided into the observation group and the control group.The control group was only treated with lifestyle intervention,while the observation group was combined with orlistat capsule 120 mg/d,3 times/d with meals.After 16 weeks of treatment,the changes of metabolic index,visceral fat area(VFA)and GLP-1 level in the two groups were analyzed.Results A total of 102 patients were included,with 52 cases in the observation group and 50 cases in the control group.After 16 weeks of treatment,triglycerides[(1.94±0.82)mmol/L vs(2.46±0.74)mmol/L],VFA[(96.54±15.57)cm^(2) vs(102.80±15.70)cm^(2)],BMI[(25.27±2.24)kg/m^(2) vs(26.13±1.96)kg/m^(2)],and waist to hip ratio(WHR)[(0.89±0.07)vs(0.92±0.06)]of the obser⁃vation group were significantly decreased compared to the control group(P<0.05);GLP-1 levels[(5.27±0.76)pmol/L vs(3.78±0.73)pmol/L],isletβ-cell function index[(78.10±11.59)vs(72.74±11.63)],and low density lipoprotein-choles⁃terin(HDL-C)[(1.35±0.22)mmol/L vs(1.16±0.26)mmol/L]of the observation group were significantly increased compared to the control group(P<0.05).Multiple linear stepwise regression analysis showed that WHR(β=-3.180,P=0.040),VFA(β=-0.013,P=0.045)and HDL-C(β=0.859,P=0.029)had a significant impact on the changes in serum GLP-1 levels.Conclusion Orlistat can improve blood glucose and lipid levels,reduce VFA and improve pancreatic islet resistance in over⁃weight or obese patients,and its clinical efficacy is closely related to the increase of GLP-1 levels.