【摘要】 目的:观察比较胰高血糖素样肽1(GLP-1)类似物艾塞那肽以及格列美脲干预治疗2型糖尿病合并肥胖患者血糖水平及心血管相关标志物水平变化探讨GLP-1心血管保护机制。方法:40例诊断2型糖尿病合并肥胖患者,近3个月使用二甲双胍单药治疗达1500 mg且血糖控制不佳的患者为研究对象,按照随机数字表法分为两组。艾塞那肽组采用艾塞那肽5μg,2次/d,皮下注射,1个月之后剂量增至10μg,2次/d,皮下注射;格列美脲组采用格列美脲2 mg,1次/d起始,根据患者的血糖情况适当调节格列美脲最高剂量至4 mg,1次/d。治疗24周后,观察两组体重、BMI、腰围、空腹血糖、餐后2 h血糖、血脂、糖化血红蛋白(Hb A1c)、Hcy、Lp-PLA2、HOMA-IR、HOMA-IS水平改变。结果:与治疗前相比,两组治疗后空腹、餐后2 h血糖及Hb A1c水平均显著降低(P<0.05),但两组比较差异均无统计学意义(P>0.05)。艾塞那肽组体重、BMI、腰围、血脂、Hcy、Lp-PLA2、HOMA-IR、HOMA-IS较治疗前均明显下降(P<0.05),而格列美脲组无明显变化。结论:艾塞那肽降糖效果与格列美脲相当,但其可通过有效降低体重、改善胰岛素抵抗并降低心血管相关危险因素水平,从而发挥心血管保护作用。更多还原

【Abstract】 Objective:To investigate cardiovascular protective mechanism of glucagon-like peptide-1 by observing and comparing the levels of blood glucose and markers for cardiovascular disease in type 2 diabetes mellitus combined with obesity and the effect of glimepiride and exenatide on these markers.Method:This study included 40 obese T2 DM patients had been treated with poorly controlled diabetes using Metformin(1500 mg) in the latest 3 months.The patients were randomly divided into Exenatide group and Glimepiride group.Subcutaneous injection of 5 μg Exenatide twice a day were applied to Exenatide group,dosage was increased to 10 μg after 1 month.Initial dose of Glimepiride was 2 mg,once a day,according the situation of blood glucose in patients to appropriate adjusting the dose of Glimepiride to highest dose to 4 mg, once a day.The body mass index(BMI),waistline,fasting blood-glucose,2-hour post-meal blood glucose,lipids,Hb A1 c,HOMAIR,HOMA-IS and the markers for cardiovascular disease including homocysteine(Hcy) and 1ipoproteinassociated phospholipase A2(Lp-PLA2)were detected at 24 weeks after the patients being treated.Result:The levels of blood glucose and Hb A1 c decreased in both two groups after treatment,but there were no significant differences between two groups(P>0.05).The levels of BMI,waistline,blood lipid,Hcy,Lp-PLA2 were dramatically reduced after administration of Exenatide group(P<0.05),but Glimepiride group had no obvious changes.Conclusion:Exenatide has similar blood glucose lowering effect as Glimepiride,exenatide plays a role of cardiovascular protection by reducing levels of cardiovascular risk factors through reducing the body weight and improving insulin resistance.更多还原