【摘要】 目的 探讨恩格列净联合德谷胰岛素治疗2型糖尿病(T2DM)的疗效及对患者糖脂代谢和胰岛素抵抗的影响。方法 选择2019年12月至2020年12月韶关市铁路医院内分泌科收治的60例T2DM患者进行研究，按随机数表法分为观察组和对照组各30例。对照组患者给予德谷胰岛素治疗，观察组患者在对照组治疗的基础上联合恩格列净治疗，两组均连续治疗3个月。治疗3个月后比较两组患者的临床疗效、治疗前后的血脂总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白(LDL-C)、血糖[空腹血糖(FBG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbA1c)、胰岛β细胞分泌指数(HOMA-β)、胰岛素抵抗指数(HOMA-IR)及治疗期间不良反应的发生情况。结果 治疗后，观察组患者的临床疗效总有效率为93.33%，明显高于对照组的73.33%，差异具有统计学意义(P<0.05)；治疗后，观察组患者的血脂代谢指标FBG、2 hPG、HbA1c、TC、TG、HDL-C、LDL-C分别为(5.40±0.55) mmol/L、(8.06±1.37) mmol/L、(6.28±1.13)%、(4.85±0.32) mmol/L、(1.45±0.08) mmol/L、(3.74±0.65) mmol/L、(1.91±0.42) mmol/L，胰岛素抵抗指标HOMA-β、HOMA-IR分别为54.24±3.40、2.46±0.72，对照组患者的血脂代谢指标FBG、2 h PG、HbA1c、TC、TG、HDL-C、LDL-C分别为(7.82±0.47) mmol/L、(11.15±1.92) mmol/L、(6.94±1.06)%、(5.64±0.67) mmol/L、(1.77±0.10) mmol/L、(2.69±0.73) mmol/L、(2.40±0.55) mmol/L，胰岛素抵抗指标HOMA-β、HOMA-IR分别为35.02±3.37、3.57±0.85，观察组FBG、2 hPG、HbA1c、TC、TG、LDL-C、HOMA-IR水平均明显低于对照组，HDL-C水平及HOMA-β水平均明显高于对照组，差异均具有统计学意义(P<0.05)；观察组患者治疗期间的总不良反应发生率为13.33%，略高于对照组的6.67%，但差异无统计学意义(P>0.05)。结论 恩格列净联合德谷胰岛素治疗T2DM能明显调节患者的血脂代谢水平，有效改善胰岛素抵抗的状态，临床治疗效果显著且安全性较高。更多还原

【Abstract】 Objective To study clinical efficacy of Enpagliflozin combined with Insulin Degludec in the treatment of type 2 diabetes mellitus(T2DM) and its influence on glucose and lipid metabolism and insulin resistance.Methods A total of 60 T2DM patients admitted to Department of Endocrinology, Shaoguan Railway Hospital from December 2019 to December 2020 were selected and divided into an observation group and a control group according to random number table, with 30 patients in each group. The patients in the control group were treated with Insulin Degludec, and the patients in the observation group were treated with Empagliflozin on the basis of the treatment in the control group, and both for 3 consecutive months. After 3 months of treatment, the clinical efficacy, total cholesterol(TC),triglycerides(TG), high density lipoprotein cholesterol(HDL-C), and low density lipoprotein(LDL-C) of the two groups were compared before and after treatment, as well as fasting blood glucose(FBG), 2 h postprandial blood glucose(2 hPG), glycosylated hemoglobin(HbA1c), pancreatic β-cell secretion index(HOMA-β), insulin resistance index(HOMA-IR) changes, and incidence of adverse reactions during treatment. Results After treatment, the total effective rate of the observation group was 93.33%, which was significantly higher than 73.33% of the control group(P<0.05). After treatment, the blood lipid metabolism indexes(FBG, 2 h PG, HbA1c, TC, TG, HDL-C, LDL-C) of the observation group were(5.40±0.55) mmol/L,(8.06±1.37) mmol/L,(6.28±1.13)%,(4.85±0.32) mmol/L,(1.45±0.08) mmol/L,(3.74±0.65) mmol/L,(1.91±0.42) mmol/L, and insulin resistance indicators HOMA-β, HOMA-IR were 54.24±3.40, 2.46±0.72, versus(7.82±0.47) mmol/L,(11.15±1.92) mmol/L,(6.94±1.06)%,(5.64±0.67) mmol/L,(1.77±0.10) mmol/L,(2.69 ±0.73) mmol/L,(2.40±0.55) mmol/L, 35.02±3.37, 3.57 ±0.85 in the control group; the levels of FBG, 2 hPG,Hb A1c, TC, TG, LDL-C, and HOMA-IR in the observation group were significantly lower than those of the control group, and the levels of HDL-C and HOMA-β were significantly higher than those of the control group; the differences were statistically significant(P<0.05). The incidence of adverse reactions in the observation group and the control group during treatment were 13.33% and 6.67%, and the difference was not statistically significant(P>0.05). Conclusion The Empagliflozin combined with Insulin Degludec in the treatment of T2DM can significantly regulate the blood lipid metabolism level of patients and effectively improve the state of insulin resistance, with significant clinical treatment effect and high safety.更多还原