【摘要】 目的观察艾塞那肽治疗肥胖2型糖尿病（T2DM）并发阻塞性睡眠呼吸暂停综合征（OSAHS）的临床疗效。方法选取2014年8月至2016年8月新乡市第一人民医院内分泌科收治的T2DM并发OSAHS肥胖患者80例,随机分为对照组和观察组,每组40例。对照组患者口服盐酸二甲双胍片850 mg,每日2次,共24周;观察组患者在对照组治疗的基础上加用艾塞那肽10μg,餐前1 h皮下注射,每日2次,共24周。比较2组患者治疗前后空腹血糖（FBG）、餐后2 h血糖（2 h PBG）、糖化血红蛋白（Hb A1C）水平、体质量指数（BMI）、腰围、总胆固醇（TC）、三酰甘油（TG）、呼吸暂停低通气指数（AHI）、Epworth嗜睡量表（ESS）评分、睡眠最低血氧饱和度（LSpO₂）。结果治疗前2组患者Hb A1C、FPG、2 h PBG水平比较差异均无统计学意义（P>0.05）;治疗后2组患者Hb A1C、FPG、2 h PBG水平均较治疗前明显下降（P<0.05）;治疗后,观察组患者Hb A1C、FPG、2 h PBG水平低于对照组（P<0.05）;治疗前2组患者的BMI、腰围及TC、TG水平比较差异均无统计学意义（P>0.05）。治疗后2组患者BMI、腰围及TC、TG水平均较治疗前明显下降（P<0.05）;治疗后,观察组患者BMI、腰围及TC、TG水平均较对照组明显下降（P<0.05）。治疗前2组患者AHI、ESS评分及SpO₂、LSpO₂水平比较差异均无统计学意义（P>0.05）;治疗后2组患者AHI、ESS评分及SpO₂、LSpO₂水平均较治疗前明显下降（P<0.05）;治疗后,观察组患者AHI、ESS评分及SpO₂、LSpO₂水平均较对照组明显下降（P<0.05）。观察组和对照组患者不良反应发生率分别为7.5%（3/40）和5.0%（2/40）,2组患者不良反应发生率比较差异无统计学意义（P>0.05）。结论艾塞那肽能够有效控制血糖,改善β细胞功能和减轻胰岛素抵抗;还能有效降低患者体质量、BMI和腰围,改善睡眠呼吸质量。更多还原

【Abstract】 Objective To observe the clinical effect of exenatide for treatment of obesity type 2 diabetes mellitus（ T2DM） complicated with obstructive sleep apnea hypopnea syndrome（ OSAHS）. Methods Eighty patients of obesity T2DM complicated with OSAHS in the Department of Endocrinology,the First People’s Hospital of Xinxiang from August 2014 to August 2016 were chosen and randomly divided into observation group（ n = 40） and control group（ n = 40）. The patients in control group taken orally metformin 800 mg twice daily for 24 weeks; based on this,the patients in observation group were injected subcutaneously exenatide 10 μg at one hour before meal,twice daily for 24 weeks. The fasting blood glucose（ FBG）,2-hour postprandial blood glucose（ 2 h PBG）,glycosylated hemoglobin（ Hb A1 C）,body mass index（ BMI）,waistline,total cholesterol（ TC）,triglyceride（ TG）,apnea hypoventilation index（ AHI）,Epworth sleepiness scale（ ESS） score,the lowest oxygen saturation in sleep（ LSpO₂） were compared between the two groups before and after treatment. Results There was no statistic difference in the Hb A1 C,FPG,2 h PBG levels of patients between the two groups before treatment（ P > 0. 05）; the Hb A1 C,FPG,2 h PBG levels of patients in the two groups after treatment were significantly lower than those before treatment（ P <0. 05）; and the Hb A1 C,FPG,2 h PBG levels of patients in observation group were significantly lower than those in the control group after treatment（ P < 0. 05）. There was no statistic difference in the BMI,waistline and TC,TG levels of patients between the two groups before treatment（ P > 0. 05）; the BMI,waistline and TC,TG levels of patients in the two groups after treatment were significantly lower than those before treatment（ P < 0. 05）; and the BMI,waistline and TC,TG levels of patients in observation group were significantly lower than those in the control group after treatment（ P < 0. 05）. There was no statistic difference in the AHI,ESS scores,SpO₂ and LSpO₂ levels of patients between the two groups before treatment（ P > 0. 05）; the AHI,ESS scores,SpO₂ and LSpO₂ levels of patients in the two groups after treatment were significantly lower than those before treatment（ P < 0. 05）; and the AHI,ESS scores,SpO₂ and LSPO2 levels of patients in observation group were significantly lower than those in the control group after treatment（ P < 0. 05）. The incidence of adverse reaction of patients in observation group and control group was 7. 5%（ 3/40） and 5. 0%（ 2/40） respectively; there was no statistic difference in the incidence of adverse reaction between the two groups（ P > 0. 05）. Conclusion Exenatide can effectively control blood glucose,improve the function of beta cells and reduce insulin resistance. It can effectively reduce body weight,BMI and waistline,improve the quality of sleep breathing.更多还原