谢菲++罗琳++阮凌燕++王筱景++王丽群

[摘要] 目的 探討利拉鲁肽对比甘精胰岛素治疗肥胖2型糖尿病的临床疗效。 方法 纳入40例我院就诊的二甲双胍单药治疗效果不佳的肥胖2型糖尿病患者，随机分为实验组、对照组，实验组给予利拉鲁肽针，对照组给予甘精胰岛素针。观察两组治疗前及治疗12周后空腹血糖、餐后2 h血糖、糖化血红蛋白、总胆固醇、甘油三脂、体重指数、胰岛细胞功能指数（Homa-β）和胰岛素抵抗指数（Homa-IR）及记录不良反应事件。 结果 经12周治疗后，两组患者空腹血糖、餐后2 h血糖、糖化血红蛋白、胰岛素抵抗指数较治疗前明显下降，胰岛β细胞功能指数明显升高，与治疗前相比差异有统计学意义（P<0.05），但组间比较差异无统计学意义（P>0.05）；治疗后实验组体重指数、胆固醇、甘油三脂与治疗前相比差异有统计学意义（P<0.05），组间比较实验组较对照组明显下降，差异有统计学意义（P<0.05），两组患者不良事件发生率差异无统计学意义（P>0.05）。 结论 利拉鲁肽和甘精胰岛素均可有效改善肥胖2型糖尿病患者的血糖、糖化血红蛋白等指标，改善胰岛β细胞功能，低血糖发生率及胃肠道反应均较低，利拉鲁肽比甘精胰岛素更能有效地降低患者的体重，改善血脂，更适合肥胖的2型糖尿病患者。

[关键词] 2型糖尿病；肥胖；利拉鲁肽；甘精胰岛素

[中图分类号] R587.1 [文献标识码] B [文章编号] 1673-9701（2017）10-0031-04

Clinical comparative observation of Liraglutide compared with insulin glargine in the treatment of obesity type 2 diabetes mellitus

XIE Fei1 LUO Lin2 RUAN Lingyan1 WANG Xiaojing1 WANG Liqun1

1.Department of Endocrinology， Ningbo Yinzhou Second Hospital， Ningbo 315100， China； 2.Ningbo University School of Medicine， Ningbo 315211， China

[Abstract] Objective To investigate the clinical efficacy of liraglutide compared with insulin glargine in the treatment of obesity type 2 diabetes mellitus. Methods 40 patients with obese type 2 diabetes mellitus who were treated with metformin monotherapy with poor efficacy in our hospital were randomly divided into control group and experimental group. The experimental group was treated with liraglutide injection and the control group was given insulin glargine needle. The levels of fasting blood glucose， 2-hour postprandial blood glucose， glycosylated hemoglobin， total cholesterol，triglyceride， body mass index， islet cell function index（Homa-β）， insulin resistance index （Homa-IR） and adverse events were measured before and after 12 weeks of treatment. Results After 12 weeks of treatment， the fasting blood glucose， 2-hour postprandial blood glucose， glycosylated hemoglobin and insulin resistance index in both groups were significantly lower than those before treatment， and the β-cell function index significantly increased， significantly different from those before treatment（P<0.05）. While there was no significant difference between the two groups（P>0.05）. After treatment，the body mass index， cholesterol and triglyceride in the experimental group were statistically different from those before treatment（P<0.05） and were significantly lower than those in the control group. The difference between the two groups was statistically significant（P<0.05）. There was no significant difference in the incidence of adverse events between the two groups（P>0.05）. Conclusion Both liraglutide and insulin glargine can effectively improve the blood glucose， glycosylated hemoglobin and other indicators of obese type 2 diabetes mellitus， and can also improve the function of pancreatic β cells. The incidences of hypoglycemia and gastrointestinal reactions are low. Liloprofen is more effective in reducing the weight of patients and improving blood lipids， which is more suitable for obese patients with type 2 diabetes compared with insulin glargine.

[Key words] Type 2 diabetes mellitus； Obesity； Liraglutide； Insulin glargine

随着社会的不断发展，人们生活水平的提高，糖尿病成为当今发病率高的疾病之一，其中半数以上的2型糖尿病患者伴有超重或肥胖[1]。肥胖是2型糖尿病的独立危险因素，约70%的2型糖尿病患者死于心血管疾病，而肥胖本身是引起心血管疾病的危险因素，因此对于超重或肥胖2型糖尿病患者不仅要关注血糖，还要有效减轻或控制体重[2]。……