【摘要】 目的 探讨GLP-1受体激动剂联合达格列净治疗肥胖型2型糖尿病(T2DM)的疗效及对胰岛功能的影响。方法 肥胖型T2DM患者106例随机均分为对照组和观察组，对照组给予达格列净治疗，观察组给予GLP-1受体激动剂联合达格列净治疗；分别在治疗前、治疗3个月时，采用葡萄糖氧化酶法检测空腹血糖(FPG)和餐后2 h血糖(2 hPG),层析法检测糖化血红蛋白(HbA1c),氧化酶法和酶比色法分别检测三酰甘油(TG)和总胆固醇(TC),根据治疗后的血糖水平评估临床疗效，比较治疗前后两组患者身高、体质量及体质量指数(BMI);于治疗前、治疗后3个月时检测两组患者空腹胰岛素(FINS);联合FPG检测结果计算胰岛素抵抗指数(HOMA-IR)和胰岛β细胞功能(HOMA-β);记录两组患者不良反应发生情况。结果 治疗后，观察组FPG、2 hPG、HbA1c、TG、TC水平均低于对照组，差异有统计学意义(P<0.05);治疗后3个月时，观察组(90.6%)治疗总有效率高于对照组(75.5%)、差异有统计学意义(P<0.05);治疗后3个月时，观察组FINS、HOMA-IR低于对照组，HOMA-β高于对照组，差异有统计学意义(P<0.05);治疗后3个月时，观察组患者BMI低于对照组、差异有统计学意义(P<0.05);两组不良反应发生率比较、差异无统计学意义(P>0.05)。结论 GLP-1受体激动剂联合达格列净治疗肥胖型T2DM的疗效较好，其机制可能与两药联用调节患者体内糖脂代谢、保护胰岛功能有关。更多还原

【Abstract】 Objective To investigate therapeutic efficacy of GLP-1 receptor agonist combined with dapagliflozin in treating obese type 2 diabetes mellitus(T2DM) and the effect on islet function. Methods A total of 106 obese patients with T2DM were randomly divided into a control group and an observation group. Control group was treated with dapagliflozin, while the observation group was treated with GLP-1 receptor agonist combined with dapagliflozin. Glucose oxidase method was applied to measure fasting blood glucose(FPG) and 2-hour postprandial blood glucose(2 hPG) before and after treatment. Chromatography was used to examine glycated hemoglobin(HbA1c). Triglycerides(TG), and total cholesterol(TC) were measured using oxidase method and enzyme colorimetric method, respectively. Blood glucose level after treatment was used to evaluate clinical efficacy. The height, body mass and body mass index(BMI) were compared before and after treatment between two groups of the patients. Fasting insulin(FINS) of two groups was before and after treatment measured. Insulin resistance index(HOMA-IR) and pancreatic β cell function(HOMA-β) were calculated based on the results of FINS and FPG tests. The occurrence of adverse reactions in two groups was recorded. Results After treatment, the levels of FPG, 2 hPG, HbA1c, TG, and TC in observation group were lower than those in control group(P<0.05). After 3 months of treatment, the total effective rate of treatment was significantly higher in observation group than that of control group(90.6% versus 75.5%, P<0.05). After treatment, FINS and HOMA-IR were lower in observation group than those in control group, while HOMA-β was higher than that in control group(P<0.05). After treatment, BMI of observation group was lower than that of control group(P<0.05). There was no statistically significant difference in the incidence of adverse reactions between two groups(P>0.05). Conclusion The combination of GLP-1 receptor agonists and dapagliflozin has a good therapeutic effect on obese T2DM, and its mechanism might be related to regulating glucose and lipid metabolism in patients, protecting islet function.更多还原