郭桂喜+李娟娟+刘传梅+徐建祥+闫晓芸+李慧+张磊+董砚虎

[摘要] 目的 探讨GLP-1受体激动剂对2型糖尿病（T2DM）患者短期与长期代谢控制的影响。方法 选取2010~2013年于青岛市内分泌糖尿病医院应用艾塞那肽治疗的120例T2DM患者，根据使用时间分两组：使用时间≤24周（A组，n=58），使用时间＞24周（B组，n=62）。分别记录治疗前后体重、WC、HC、FBG、P2hBG、HbA1C、TG、TC、LDL、HDL、SBP、DBP，并计算BMI、WSR、WHR，均行骨密度检查，测定全身脂肪含量。结果 A、B两组体重、BMI、全身脂肪含量均较治疗前下降，但组间差异无统计学意义（P＞0.05）；A、B两组WC、WSR、FBG、P2hBG、HbA1C、SBP、DBP均较治疗前下降，组间比较差异有统计学意义（P＜0.05）。两组TG、TC、LDL、HDL较治疗前后及组间差异无统计学意义（P＞0.05）。两组胃肠道不良反应及低血糖发生率组间差异无统计学意义（P＞0.05）。 结论 长期应用GLP-1受体激动剂治疗2型糖尿病临床疗效较好，不增加胃肠道及低血糖反应发生风险，使体脂重新分布，改善腹型肥胖及胰岛素抵抗。

[关键词] 2型糖尿病；艾塞那肽；体脂分布

[中图分类号] R587.1   [文献标识码] A   [文章编号] 2095-0616（2014）09-25-03

Investigate the effect of the GLP-1 receptor agonist on patients with type 2 diabetes mellitus （T2DM） between the short-term and long-term metabolic control

GUO Guixi1  LI Juanjuan1  LIU Chuanmei1  XU Jianxiang1  YAN Xiaoyun1  LI Hui1ZHANG Lei2  DONG Yanhu2

1.Clinical Medicine of Weifang Medical College, Weifang 261042, China; 2.Qingdao Endocrinology Diabetes Hospital, Qingdao 266071, China

[Abstract] Objective To Investigate the effect of the GLP-1 receptor agonist on patients with type 2 diabetes mellitus (T2DM) between the short-term and long-term metabolic control. Methods 120 patients with T2DM treated with Exenatide in Qingdao Endocrinology Diabetes Hospital from 2010 to 2013 were divided into two groups due to the term of drug use. Patients in group A (n=58) applied Exenatide not less than 24 weeks， while those in goup B (n=62) more than 24 weeks. Indicates included body weight (before and after the treatment), WC, HC, FBG, P2Hbg, HbA1C, TG, TC, LDL, HDL, SBP, DBP, BMI, WSR, WHR, BMD, and body fat content. Results The body weight, BMI and the body fat content in two groups were both decreased than that before treatment, which had no significant difference in the comparison between groups (P＞0.05); WC, WSR, FBG, P2hBG, HbA1C, SBP, DBP in two groups were both decreased than that before treatment, which had statistically significant difference in the comparison between the two groups (P＜0.05).TG, TC, LDL, HDL in two groups had no statistically different neither before nor after treatment (P＞0.05). Neither the gastrointestinal adverse reaction nor the rate of hypoglycemia in the two groups had no statistically different in the comparison between groups (P＞0.05). Conclusion The better clinical effect of GLP-1 receptor agonists for T2DM lies in long-term application, which can also decrease the risk of the gastrointestinal reactions and hypoglycemia, redistribute the body fat and improve abdominal obesity and insulin resistance.

[Key words] Type 2 diabetes mellitus; Exenatide; Body fat distribution

艾塞那肽是一种胰高糖素样肽-1（GLP-1）类似物，通过激动GLP-1受体，刺激葡萄糖依赖的胰岛素分泌[1-2]，在临床中已大量应用，主要作用是控制血糖、减轻体重、改善胰岛素抵抗。然而，艾塞那肽使用时间尚无定论，目前尚未有研究探讨短期与长期应用是否对重要代谢指标产生不同的影响，本研究通过对120例T2DM病例的分析，探讨GLP-1受体激动剂短期与长期应用对重要代谢指标控制的影响，指导GLP-1受体激动剂临床应用时间，以期达最佳治疗效果。

表1  两组一般情况及治疗前后各项代谢指标……