度拉糖肽和利拉鲁肽联合二甲双胍对2型糖尿病肥胖患者的疗效比较

Effects of dulaglutide and liraglutide combined with metformin in obese patients with type 2 diabetes mellitus:a comparative study

目的比较度拉糖肽和利拉鲁肽联合二甲双胍对2型糖尿病(T2DM)肥胖患者的疗效以及对补体C1q/肿瘤坏死因子相关蛋白3(CTRP3)和血管细胞黏附分子1(VCAM‑1)的影响。方法选取南通大学附属南通第三医院2019年3月至2022年9月收治的89例T2DM肥胖患者为研究对象,随机分为利拉鲁肽组45例和度拉糖肽组44例。利拉鲁肽组予利拉鲁肽联合二甲双胍治疗,度拉糖肽组予度拉糖肽联合二甲双胍治疗。比较2组体重指数(BMI)、肥胖度、腰围、臀围、糖脂代谢相关指标、胰岛素抵抗相关指标、CTRP3和VCAM‑1水平。结果治疗后2组的BMI、肥胖度、臀围、腰围、糖脂代谢相关指标、胰岛素抵抗相关指标、CTRP3和VCAM‑1与治疗前比较差异均有统计学意义(P<0.05),并且度拉糖肽组的平均血糖波动幅度(MAGE)和VCAM‑1水平低于利拉鲁肽组(P<0.05),目标葡萄糖范围内时间(TIR)和CTRP3高于利拉鲁肽组(P<0.05)。2组治疗后其他指标比较差异均无统计学意义(P>0.05)。结论度拉糖肽与利拉鲁肽联合二甲双胍均可控制T2DM肥胖患者的血糖水平,改善糖脂代谢,但在控制MAGE和TIR方面,度拉糖肽效果更好,其机制可能与度拉糖肽能够调节CTRP3和VCAM‑1的水平相关。

Objective To compare the effects of dulaglutide and liraglutide combined with metformin on serum C1q/TNFrelated protein 3(CTRP3)and vascular cell adhesion molecule 1(VCAM‑1)in obese patients with type 2 diabetes mellitus(T2DM).Methods A total of 89 obese T2DM patients who were admitted to Affiliated Nantong Hospital of 3 Nantong University from March 2019 to September 2022 were selected as research subjects.They were randomly divided into liraglutide group(n=45,liraglutide+metformin)and dulaglutide group(n=44,dulaglutide+metformin).Body mass index(BMI),obesity degree,waist circumference,hip circumference,glucolipid metabolism related indexes,insulin resistance related indexes,CTRP3,and VCAM‑1 were compared between the two groups.Results Compared with those before treatment,BMI,obesity degree,hip circumference,waist circumference,glucolipid metabolism related indexes,insulin resistance related indexes,CTRP3,and VCAM‑1 were significantly changed after treatment(all P<0.05).Mean amplitude of glucose fluctuation(MAGE)and VCAM‑1 in the dulaglutide group were significantly lower than those in the liraglutide group after treatment,while time in target glucose range(TIR)and CTRP3 in the dulaglutide group were significantly higher than those in the liraglutide group after treatment(all P<0.05).There was no statistically significant difference in the other indexes between the two groups after treatment(all P>0.05).Conclusion Both dulaglutide and liraglutide combined with metformin can control blood glucose levels and improve glucolipid metabolism in obese T2DM patients.But dulaglutide is more effective in controlling MAGE and TIR than liraglutide,which may be related to the ability of dulaglutide to regulate the levels of CTRP3 and VCAM‑1.