2018 年第 4 期 第 13 卷

西格列汀联合二甲双胍治疗腹型肥胖2型糖尿病的临床效果及安全性

Clinical efficacy and safety of siglitatin combined with metformin in treatment of type 2 diabetes mellitus with abdominal obesity

作者：陈赟何瑶马维青王国娟

英文作者：

单位：230000合肥市第一人民医院安徽医科大学第三附属医院内分泌科

英文单位：

关键词：2型糖尿病；西格列汀；腹型肥胖

英文关键词：

• 摘要：

• 目的    探讨西格列汀联合二甲双胍治疗腹型肥胖2型糖尿病的临床效果及安全性。方法    选取2015年9月至2017年5月在合肥市第一人民医院诊治的初诊腹型肥胖2型糖尿病患者102例，后续退出此次试验4例。依据随机数字表分为对照组和观察组，各49例。观察组口服磷酸西格列汀片联合盐酸二甲双胍缓释片治疗，对照组口服盐酸二甲双胍缓释片治疗，均治疗12周。观察2组患者治疗前后腰围、臀围、体重指数、空腹血糖、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)、收缩压、舒张压、总胆固醇、三酰甘油、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)以及相关不良反应。结果    治疗后2组患者腰围、臀围、体重指数均低于治疗前，且观察组体重指数低于对照组［（21±5）kg/m2比（24±4）kg/m2］，差异均有统计学意义（均P＜0.05）。治疗后2组患者空腹血糖、2 hPG、HbA1c低于治疗前，且观察组空腹血糖、2 hPG低于对照组［（7.7±1.0）mmol/L比（9.2±1.1）mmol/L、（9.7±2.6）mmol/L比（12.2±2.0）mmol/L］，差异均有统计学意义（均P＜0.05）。治疗后2组患者FINS高于，HOMA-IR、收缩压、舒张压低于治疗前，且观察组的改善情况优于对照组，差异均有统计学意义（均P＜0.05）。治疗后2组患者总胆固醇、三酰甘油、LDL-C低于治疗前，HDL-C高于治疗前，且观察组的改善情况优于对照组，差异均有统计学意义（均P＜0.05）。观察组低血糖发生率高于对照组［14.3%（7/49）比4.1%（2/49）］，差异有统计学意义（P＜0.05）。结论    西格列汀联用二甲双胍治疗腹型肥胖2型糖尿病患者效果肯定，无体质量增加的风险，在降糖、改善胰岛素抵抗、降压、调节血脂方面较单独用药疗效果更佳，但联合用药低血糖风险较高。

• Objective    To explore the clinical efficacy and safety of siglitatin combined with metformin in treatment of type 2 diabetic patients with abdominal obesity. Methods    From September 2015 to May 2017, 102 type 2 diabetic patients with abdominal obesity were enrolled in First People′s Hospital of Hefei; 4 patients were withdrawn from the test; 98 patients were randomly divided into control group and observation group, with 49 cases in each group. The observation group took siglitatin combined with metformin and the control group took metformin for 12 weeks. Waist circumference, hip circumference, body mass index(BMI), fasting blood glucose(FBG), postprandial 2 h blood glucose(2 hPG), glycosylated hemoglobin(HbA1c), fasting insulin(FINS), insulin resistance index(HOMA-IR), systolic pressure(SBP), diastolic pressure(DBP), total cholesterol（TC）, triacylglycerol（TG）, high-density lipoprotein cholesterol(HDL-C), low-density lipoprotein cholesterol(LDL-C) and adverse reactions were analyzed. Results   After treatment, waist circumference, hip circumference and BMI were significantly lower than those before treatment in both groups; BMI in observation group was significantly lower than that in control group［（21±5）kg/m2 vs （24±4）kg/m2］(P<0.05). After treatment, FBG and 2 hPG, HbA1c were significantly lower than those before treatment in both groups; FBG and 2 hPG in observation group were significantly lower than those in control group［（7.7±1.0）mmol/L vs （9.2±1.1）mmol/L, （9.7±2.6）mmol/L vs （12.2±2.0）mmol/L］(P<0.05). After treatment, FINS was significantly higher and HOMA-IR, SBP, DBP were significantly lower than those before treatment in both groups; there were significant differences between observation group and control group(P<0.05). After treatment, TC, TG, LDL-C were significantly lower and HDL-C was significantly higher than those before treatment; there were also significant differences between observation group and control group(P<0.05). Incidence of hypoglycemia in observation group was significantly higher than that in control group［14.3%(7/49) vs 4.1%(2/49)］(P<0.05). Conclusion    Siglitatin combined with metformin treating type 2 diabetic patients with abdominal obesity can effectively reduce blood glucose, improve insulin resistance, reduce blood pressure and regulate blood lipid; but the combined medication brings a high risk of hypoglycemia.