二甲双胍联合西格列汀或瑞格列奈治疗肥胖2型糖尿病患者的效果比较

Efficacies of metformin combined with sitagliptin or repaglinide in treatment of obese patients with type 2 diabetes mellitus

目的探讨二甲双胍联合西格列汀或瑞格列奈治疗肥胖2型糖尿病患者的效果。方法选取2017年1月至2018年4月在海南省人民医院就诊的肥胖2型糖尿病患者100例。采取随机数字表法分为对照组和观察组,各50例。对照组在常规治疗基础上给予二甲双胍联合瑞格列奈片口服,观察组在常规治疗基础上给予二甲双胍联合西格列汀片口服。比较2组患者治疗前和治疗3个月后体重指数、血糖、胰岛素抵抗指数和血脂以及血清丝氨酸蛋白酶抑制物(vaspin)、瘦素、脂联素水平和不良反应的发生率。结果治疗前,2组患者各观察指标水平比较差异均无统计学意义(均P> 0. 05)。治疗3个月后,2组患者体重指数、空腹血糖、餐后2 h血糖、糖化血红蛋白、胰岛素抵抗指数、三酰甘油、总胆固醇、低密度脂蛋白胆固醇、vaspin、瘦素水平均低于治疗前,高密度脂蛋白胆固醇、脂联素水平均高于治疗前,且观察组体重指数、总胆固醇、低密度脂蛋白胆固醇、vaspin、瘦素水平低于对照组[(23. 0±2. 7) kg/m^2比(25. 7±2. 8) kg/m^2,(3. 1±0. 4) mmol/L比(4. 2±0. 5) mmol/L,(2. 21±0. 26) mmol/L比(2. 71±0. 34) mmol/L,(1. 31±0. 15)μg/L比(2. 20±0. 24)μg/L,(5. 5±0. 6)μg/L比(7. 2±0. 8)μg/L],高密度脂蛋白胆固醇、脂联素水平高于对照组[(1. 52±0. 19) mmol/L比(1. 27±0. 18) mmol/L,(8. 2±0. 9) mg/L比(4. 1±0. 4) mg/L],差异均有统计学意义(均P <0. 01)。2组患者治疗期间不良反应发生率比较差异无统计学意义(P> 0. 05)。结论在服用二甲双胍基础上口服西格列汀或瑞格列奈均能使血糖达标,但西格列汀在降低体质量、血脂方面效果更佳,且可进一步调节患者血清vaspin、瘦素、脂联素水平。

Objective To investigate the efficacies of metformin combined with sitagliptin or repaglinide in treating obese patients with type 2 diabetes mellitus.Methods From January 2017 to April 2018,100 obese patients with type 2 diabetes in Hainan General Hospital were randomly divided into control group and observation group,with 50 cases in each group.The control group took metformin plus repaglinide on the basis of routine treatment.The observation group took metformin plus sitagliptin on the basis of routine treatment.Body mass index,blood glucose,insulin resistance,blood lipids,serum serine protease inhibitor(vaspin),leptin and adiponectin were detected before and 3 months after treatment.Adverse reactions were observed.Results Before treatment,the measurements were similar between groups(P>0.05).After 3 months of treatment,body mass index,fasting blood glucose,2 h postprandial blood glucose,glycosylated hemoglobin,insulin resistance index,triglyceride,total cholesterol,low-density lipoprotein cholesterol,vaspin and leptin levels significantly decreased and high-density lipoprotein cholesterol and adiponectin levels significantly increased compared to those before treatment;body mass index,total cholesterol,low-density lipoprotein cholesterol,vaspin and leptin levels in observation group were lower than those in control group[(23.0±2.7)kg/mg^2 vs(25.7±2.8)kg/mg^2,(3.1±0.4)mmol/L vs(4.2±0.5)mmol/L,(2.21±0.26)mmol/L vs(2.71±0.34)mmol/L,(1.31±0.15)μg/L vs(2.20±0.24)μg/L,(5.5±0.6)μg/L vs(7.2±0.8)μg/L];high-density lipoprotein cholesterol and adiponectin levels in observation group were higher than those in control group[(1.52±0.19)mmol/L vs(1.27±0.18)mmol/L,(8.2±0.9)mg/L vs(4.1±0.4)mg/L](all P<0.01).There was no significant difference of the incidence of adverse reactions between groups(P>0.05).Conclusions Metformin plus sitagliptin or repaglinide can effectively regulate blood glucose.Sitagliptin is effective in reducing body mass and blood lipids,regulating serum vaspin,leptin and adiponectin.