恩格列净联合利拉鲁肽对肥胖型2型糖尿病患者糖脂代谢及血清分泌型卷曲相关蛋白5、鸢尾素、总脂联素水平的调节作用

    Regulating effect of empagliflozin plus liraglutide on glucose/lipid metabolism and serum levels of SFRP5, Irisin and tAPN in obese type 2 diabetics

      摘要
    • 摘要: 目的 探讨恩格列净联合利拉鲁肽对肥胖型2型糖尿病（type 2 diabetes，T2DM）患者糖脂代谢及血清分泌型卷曲相关蛋白5（secreted frizzled-related protein 5，SFRP5）、鸢尾素（Irisin）、总脂联素（total adiponectin，tAPN）水平的调节效应。方法 选取2019年3月至2021年3月邯郸市中心医院肥胖型T2DM患者116例，以随机抽签法分为观察组（n=58）、对照组（n=58）。对照组给予利拉鲁肽治疗，观察组在对照组基础上联合恩格列净治疗，均治疗3个月。比较两组治疗前、治疗3个月后减重有关指标［体重、腰围、体重指数（body mass index，BMI）］、糖代谢指标［糖化血红蛋白（glycatedhemoglobin，HbA1c）、空腹血糖（fasting blood glucose，FPG）、餐后2 h血糖（2 h postprandial blood glucose，2 hPG）］、脂代谢指标［低密度脂蛋白胆固醇（low density lipoprotein cholesterol，LDL-C）、高密度脂蛋白胆固醇（high density lipoprotein cholesterol，HDL-C）、三酰甘油（triglycerides，TG）、总胆固醇（total cholesterol，TC）］、胰岛素敏感性有关指标［稳态模型胰岛β细胞功能指数（homeostasis model islet β cell function index，HOMA-β）、稳态模型胰岛素抵抗指数（homeostasis model insulin resistance index，HOMA-IR）］、血清SFRP5、Irisin、tAPN水平，并统计不良反应发生情况。结果 观察组与对照组相比治疗3个月后体重［（74.93±2.68）kg比（78.21±3.47）kg］、腰围［（90.40±2.17）cm比（93.28±2.53）cm］、BMI［（26.57±0.94）kg/m2比（27.94±1.06）kg/m2］、HbA1c［（6.03±0.59）%比（6.76±0.68）%］、FPG［（6.24±0.73）mmol/L比（6.97±0.95）mmol/L］、2 hPG［（8.06±1.25）mmol/L比（8.83±1.50）mmol/L］、LDL-C［（2.27±0.21）mmol/L比（2.58±0.27）mmol/L］、TG［（1.83±0.34）mmol/L比（2.20±0.48）mmol/L］、TC［（5.36±0.42）mmol/L比（5.92±0.53）mmol/L］、HOMA-IR（2.35±0.24比2.69±0.31）水平均下降（P<0.05），HDL-C［（1.50±0.38）mmol/L比（1.19±0.25）mmol/L］、HOMA-β（68.94±13.26比57.52±10.39）及血清SFRP5、Irisin、tAPN水平均升高（P<0.05）；观察组治疗期间不良反应发生率17.24%与对照组12.07%相比，差异无统计学意义（P>0.05）。结论 应用恩格列净联合利拉鲁肽治疗肥胖型T2DM患者可改善糖脂代谢与胰岛素敏感性，提高血清SFRP5、Irisin、tAPN水平，提升减重效果，且具有安全性。

       

      Abstract: Objective To explore the effects of enpagliflozin plus liraglutide on glucose/lipid metabolism and regulating the serum levels of secreted frizzled-related protein 5(SFRP5),Irisin and total adiponectin(tAPN). Methods From March 2019 to March 2021,116 obese T2DM patients were randomized into two groups of observation(n=58)and control(n=58). Control group received liraglutide for 3 months while observation group had empagliflozin on the basis of control group for 3 months. At pre-treatment and 3 months post-treatment,two groups were compared regarding the parameters of weight lossweight,waist circumference(WC),body mass index(BMI),glucose metabolismglycated hemoglobin(HbA1c),fasting blood glucose(FPG),2 h postprandial blood glucose(2 hPG), lipid metabolismlow-density lipoprotein cholesterol (LDL-C),high-density lipoprotein cholesterol (HDL-C),triglycerides(TG),total cholesterol(TC),insulin sensitivityhomeostasis model islet β cell function index(HOMA-β),homeostasis model insulin resistance index(HOMA-IR),serum levels of SFRP5,Irisin and tAPN and occurrences of adverse reactions. Results After 3-month treatment, body weight(74. 93±2. 68)vs(78. 21±3. 47)kg,WC(90. 40±2. 17)vs(93. 28±2. 53)cm, BMI(26. 57±0. 94)vs(27. 94±1. 06)kg/m2,HbA1c(6. 03±0. 59)% vs(6. 76±0. 68)%, FPG(6. 24±0. 73)vs(6. 97±0. 95)mmol/L,2 hPG(8. 06±1. 25)vs(8. 83±1. 50)mmol/L, LDL-C(2. 27±0. 21)vs(2. 58±0. 27)mmol/L,TG(1. 83±0. 34)vs(2. 20±0. 48)mmol/L, TC(5. 36±0. 42)vs(5. 92±0. 53)mmol/Land HOMA-IR(2. 35±0. 24 vs 2. 69±0. 31)were lower in observation group than those in control group(P<0. 05). And the serum levels of SFRP5,Irisin and tAPN were higher in control group than those in control group(P<0. 05);The incidence of adverse reactions was 17. 24% in observation group versus 12. 07% in control group. And the difference was not statistically significant(P>0. 05). Conclusion For obese T2DM patients,enpagliflozin plus liraglutide may improve glucose/lipid metabolism and insulin sensitivity,boost serum levels of SFRP5, Irisin and tAPN and accelerate weight loss. The safety profile is decent.

       

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