度拉糖肽联合甘精胰岛素治疗2型糖尿病患者的疗效观察

Efficacy observation of dulaglutide combined with insulin glargine in treating patients with type 2 diabetes mellitus

目的探讨度拉糖肽联合甘精胰岛素对2型糖尿病患者糖脂代谢、胰岛功能、氧化应激、骨代谢指标的影响。方法将98例2型糖尿病患者随机分为甘精胰岛素组和联合组,每组49例。甘精胰岛素组使用甘精胰岛素联合二甲双胍治疗,联合组使用度拉糖肽、甘精胰岛素联合二甲双胍治疗。比较2组患者治疗前后血糖、血脂、胰岛功能指标水平;采用酶标分析仪检测氧化应激指标水平;采用免疫透射比浊法检测骨代谢指标;计算2组尿微量白蛋白与尿肌酐比值(UACR),比较2组治疗效果。结果治疗后,联合组空腹血糖(FPG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbA1c)水平均低于甘精胰岛素组,差异有统计学意义(P<0.05)。治疗后,联合组总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)水平低于甘精胰岛素组,高密度脂蛋白(HDL)水平高于甘精胰岛素组,差异有统计学意义(P<0.05)。治疗后,联合组胰岛β细胞功能指数(HOMA-IS)高于甘精胰岛素组,胰岛素抵抗指数(HOMA-IR)低于甘精胰岛素组,差异有统计学意义(P<0.05)。治疗后,联合组过氧化氢酶(CAT)、骨钙素(OC)水平高于甘精胰岛素组,过氧化脂质(LPO)、β-胶原降解产物(β-CTX)水平低于甘精胰岛素组,差异有统计学意义(P<0.05)。治疗后,联合组UACR水平为(33.26±3.37)mg/g,高于甘精胰岛素组的(25.49±2.83)mg/g,差异有统计学意义(P<0.05)。联合组治疗总有效率为93.88%,高于甘精胰岛素组的79.59%,差异有统计学意义(P<0.05)。结论度拉糖肽联合甘精胰岛素能够有效调节2型糖尿病患者血糖及血脂水平,改善患者胰岛功能,减轻氧化应激反应,改善骨代谢,调节UACR水平。

Objective To investigate the effects of dulaglutide combined with insulin glargine on glucose and lipid metabolism,pancreatic islet function,oxidative stress and bone metabolism indicators in patients with type 2 diabetes mellitus.Methods A total of 98 patients with type 2 diabetes mellitus were randomly divided into insulin glargine group and combined group,with 49 cases in each group.The insulin glargine group was treated with insulin glargine and metformin,while the combined group was treated with dulaglutide,insulin glargine and metformin.The levels of blood glucose,blood lipids and pancreatic islet function were compared between the two groups before and after treatment;enzyme immunoassay analyzer was used to detect the levels of oxidative stress indicators;immunoturbidimetry was used to detect bone metabolism indicators;the urinary microalbumin to creatinine ratio(UACR)was calculated in both groups,and the therapeutic effect was compared between the two groups.Results After treatment,the levels of fasting plasma glucose(FPG),2-hour postprandial glucose(2 hPG)and glycated hemoglobin(HbA1c)in the combined group were significantly lower than those in the insulin glargine group(P<0.05).After treatment,the levels of total cholesterol(TC),triglycerides(TG)and low-density lipoprotein cholesterol(LDL-C)in the combined group were significantly lower than those in the insulin glargine group,while the level of high-density lipoprotein(HDL)was significantly higher than that in the insulin glargine group(P<0.05).After treatment,the homeostatic model assessment of insulin secretion(HOMA-IS)in the combined group was significantly higher than that in the insulin glargine group,while the homeostatic model assessment of insulin resistance(HOMA-IR)was significantly lower than that in the insulin glargine group(P<0.05).After treatment,the levels of catalase(CAT)and osteocalcin(OC)in the combined group were significantly higher than those in the insulin glargine group,while the levels of lipid peroxide(LPO)andβ-collagen degradation products(β-CTX)were significantly lower than those in the insulin glargine group(P<0.05).After treatment,the UACR in the combined group was(33.26±3.37)mg/g,which was significantly higher than(25.49±2.83)mg/g in the insulin glargine group(P<0.05).The total effective rate in the combined group was 93.88%,which was significantly higher than 79.59%in the insulin glargine group(P<0.05).Conclusion Dulaglutide combined with insulin glargine can effectively regulate the blood glucose and lipid levels of patients with type 2 diabetes,improve the function of pancreatic islets,alleviate the oxidative stress reaction,improve bone metabolism,and regulate the UACR level.