【摘要】 目的:观察利拉鲁肽对腹型肥胖2型糖尿病(T2DM)患者肠道菌群及脂肪细胞因子水平的影响。方法:128例腹型肥胖T2DM患者随机分为两组。两组均给予常规降糖方案治疗，在此基础上，对照组加用小剂量利拉鲁肽(初始剂量0.6 mg qd, 1周后剂量增加至1.2 mg qd),观察组加用大剂量利拉鲁肽(初始剂量0.6 mg qd, 2周后剂量增加至1.8 mg qd)。治疗3个月后，比较两组血糖水平[空腹血糖(FPG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbA1c)、平均血糖波动幅度(MAGE)、日间血糖平均绝对差(MODD)]、临床指标[胰岛素分泌指数(HOMA-β)、胰岛素抵抗指数(HOMA-IR)、空腹C肽、腹内脂肪含量、腰围]、肠道菌群(肠杆菌、酵母菌、双歧杆菌、乳杆菌)、脂肪细胞因子[脂联素、瘦素、爱帕琳肽(Apelin)-13]、Th17/Treg水平等指标变化，以及药品不良反应发生情况。结果:治疗后，两组患者的FPG、2 hPG、HbA1c、MAGE、MODD、HOMA-IR、腹内脂肪含量、腰围、肠杆菌、酵母菌、瘦素、Th17、Th17/Treg水平等均较前明显降低，HOMA-β、空腹C肽、双歧杆菌、乳杆菌血清脂联素、Apelin-13、Treg水平等则较前升高(P<0.05);且观察组上述指标均优于对照组(P<0.05)。两组药品不良反应发生率差异无统计学意义(P>0.05)。结论:大剂量利拉鲁肽有助于调节腹型肥胖T2DM患者脂肪细胞因子水平，改善胰岛素抵抗，纠正肠道菌群失调，控制血糖，且安全性高。更多还原

【Abstract】 Objective:To investigate the effects of liraglutide on intestinal flora and adipocytokine levels in type 2 diabetes mellitus(T2 DM) patients with abdominal obesity. Methods: One hundred and twenty-eight T2 DM patients with abdominal obesity in our hospital were selected and divided into two groups by the random number table method. Both groups were given the conventional glucose-lowering regimens, and additionally, the control group was given a small dose of liraglutide at an initial dose of 0.6 mg qd, and the dose was increased to 1.2 mg qd after one week of treatment; the observation group was given a high dose of liraglutide at an initial dose of 0.6 mg qd, and the dose was increased to 1.8 mg qd after 2 weeks of treatment. After 3 months of treatment, the blood glucose levels [fasting blood glucose(FPG), 2 h postprandial blood glucose(2 hPG), glycated hemoglobin(HbA1 c), mean amplitude of blood glucose fluctuations(MAGE), mean absolute difference between day-to-day blood glucose(MODD)], clinical indicators [insulin secretion index(HOMA-β), insulin resistance index(HOMA-IR) fasting C-peptide, intra-abdominal fat content, waistline], intestinal flora(enterobacter, yeast, bifidobacteria, lactobacillus), adipocytokines(adiponectin, leptin, epalenin Apelin-13), adipocytokines changes in Th17/Treg levels, and occurrence of adverse drug reactions were compared between the two groups. Results: After treatment, FPG, 2 hPG, HbA1 c, MAGE, MODD, HOMA-IR, leptin, Th17, Th17/Treg levels, intra-abdominal fat content, waistline, enterobacteriaceae and yeast were lower than those before treatment, and HOMA-β, fasting C-peptide levels, serum lipocalin, Apelin-13, Treg levels, bifidobacterium and lactobacillus were higher than those before treatment in both groups. All the indicators in the observation group were better than those in the control group(P<0.05). The difference in the incidence of adverse reactions between the two groups was not statistically significant(P>0.05). Conclusion: High-dose liraglutide helps regulate adipocytokine levels, improve insulin resistance, correct intestinal flora dysbiosis and control blood glucose with high safety in T2 DM patients with abdominal obesity.更多还原