达格列净联合司美格鲁肽治疗肥胖型2型糖尿病的效果及对糖脂代谢等指标的影响

Effect of dapagliflozin combined with semaglutide in the treatment of obese type 2 diabetes mellitus and its influence on glucose and lipid metabolism

目的观察达格列净联合司美格鲁肽治疗肥胖型2型糖尿病(T2DM)的效果及对糖脂代谢等指标的影响。方法回顾性选取2021年1月—2023年6月中国人民解放军联勤保障部队第九〇〇医院收治的肥胖型T2DM患者80例,根据不同治疗方法分为达格列净联合组39例和司美格鲁肽组41例,司美格鲁肽组给予司美格鲁肽治疗,达格列净联合组给予达格列净联合司美格鲁肽治疗,2组均治疗3个月。比较2组疗效,治疗前后糖脂代谢指标[空腹血糖(FPG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbA 1c)、三酰甘油(TG)、总胆固醇(TC)]、炎性因子[血清肿瘤坏死因子-α(TNF-α)、白介素-1β(IL-1β)、白介素-6(IL-6)]、肥胖指标,不良反应。结果达格列净联合组总有效率为92.31%,高于司美格鲁肽组的75.61%(χ2=4.095,P=0.043)。治疗3个月后,2组FPG、2 hPG、HbA 1c、TG、TC水平均降低,且达格列净联合组低于司美格鲁肽组(P<0.01);2组体质指数、腰围、臀围、腰臀比均降低,且达格列净联合组低于司美格鲁肽组(P<0.05或P<0.01);2组TNF-α、IL-1β、IL-6水平均降低,且达格列净联合组低于司美格鲁肽组(P<0.05或P<0.01)。达格列净联合组与司美格鲁肽组不良反应总发生率比较差异不显著(5.13%vs.2.44%,χ2=0.002,P=0.965)。结论达格列净联合司美格鲁肽治疗肥胖型T2DM效果显著,能有效改善患者糖脂代谢和体质指数,抑制炎性反应。

Objective To observe the effect of dapagliflozin combined with semaglutide in the treatment of obese type 2 diabetes mellitus(T2DM)and its effects on glucose and lipid metabolism.Methods A total of 80 obese T2DM patients admitted to the 90th Hospital of the Chinese People′s Liberation Army Joint Logistics Support Force from January 2021 to June 2023 were retrospectively selected.According to different treatment methods,they were divided into dapagliflozin combined group(39 cases)and semaglutide group(41 cases).The semaglutide group was treated with semaglutide.Dapagliflozin combined group was treated with dapagliflozin combined with semaglutide,and both groups were treated for 3 months.The efficacy,the indexes of glucose and lipid metabolism(FPG,2 hPG,HbA 1c,TG,TC),inflammatory factors(TNF-α,IL-1β,IL-6),obesity indicators before and after treatment,adverse reactions of the two groups were compared.Results The total effective rate of dapagliflozin combined group was 92.31%,which was higher than 75.61%of semaglutide group(χ2=4.095,P=0.043).After 3 months of treatment,the levels of FPG,2 hPG,HbA 1c,TG and TC in two groups were decreased,and the dapagliflozin combined group were lower than those in semaglutide group(P<0.01).Body mass index,waist circumference,hip circumference and waist-to-hip ratio were all decreased in two groups,and dapagliflozin combined group were lower than semaglutide group(P<0.05 or P<0.01).The levels of TNF-α,IL-1βand IL-6 in two groups were decreased,and the levels in dapagliflozin combined group were lower than those in semaglutide group(P<0.05 or P<0.01).There was no significant difference in the overall incidence of adverse reactions between the dapagliflozin combined group and the semaglutide group(5.13%vs.2.44%,χ2=0.002,P=0.965).Conclusion Dapagliflozin combined with semaglutide is effective in the treatment of obese T2DM,which can effectively improve glucose and lipid metabolism and body mass index,and inhibit inflammatory response.