标题：利拉鲁肽联合胰岛素及二甲双胍治疗初诊2型糖尿病的疗效及对患者血清Hcy、CysC、hs-CRP水平及糖脂代谢的影响

      作者：石敏，王琼，李文娟，李晓苗    空军军医大学第一附属医院内分泌代谢科，陕西 西安 710032

      卷次： 2022年33卷15期

      【摘要】 目的 探讨利拉鲁肽联合胰岛素及二甲双胍治疗初诊 2型糖尿病的疗效及对血清同型半胱氨酸(Hcy)、胱抑素C (Cys C)、超敏C反应蛋白(hs-CRP)水平及糖脂代谢的影响。方法 选取2019年11月至2021年11月于空军军医大学第一附属医院内分泌代谢科治疗的初诊2型糖尿病患者176例为研究对象。按照随机单双数法分为对照组(单数)与研究组(双数)各88例。对照组患者采用胰岛素与二甲双胍治疗，研究组患者在对照组治疗的基础上采用利拉鲁肽治疗。比较两组患者治疗 1个月后的临床疗效，以及治疗前和治疗 1个月后的Hcy、CysC、hs-CRP、空腹血糖、餐后 2 h血糖、低密度脂蛋白(LDL)、总胆固醇(TC)、高密度脂蛋白(HDL)、甘油三酯(TG)水平。结果 研究组患者的治疗总有效率为96.59%，明显高于对照组的81.82%，差异有统计学意义(P<0.05)；治疗前，两组患者的Hcy、Cys C、hs-CRP水平比较差异均无统计学意义(P>0.05)；治疗后，两组患者的Hcy、Cys C、hs-CRP水平明显低于治疗前，且研究组患者的Hcy、Cys C、hs-CRP水平分别为(7.40±1.31) μmol/L、(1.35±0.30) mg/L、(2.20±0.27) mg/L，明显低于对照组的(9.03±1.47) μmol/L、(2.46±0.49) mg/L、(3.38±0.33) mg/L，差异均有统计学意义(P<0.05)；治疗前，两组患者的空腹血糖、餐后2 h血糖、LDL、TC、HDL、TG水平比较差异均无统计学意义(P>0.05)；治疗后，研究组患者的空腹血糖、餐后2 h血糖、LDL、TC、TG水平分别为(6.23±0.41) mmol/L、(8.08±0.74) mmol/L、(2.61±0.44) mmol/L、(3.84±0.70) mmol/L、(1.77±0.23) mmol/L，明显低于对照组的(6.91±0.38) mmol/L、(9.25±0.96) mmol/L、(3.54±0.59) mmol/L、(4.80±0.67) mmol/L、(2.31±0.19) mmol/L，HDL水平为(1.56±0.15) mmol/L，明显高于对照组的(1.26±0.13) mmol/L，且两组患者的血糖、餐后2 h血糖、LDL、TC、TG水平明显低于治疗前，HDL水平明显高于治疗前，差异均有统计学意义(P<0.05)。结论 利拉鲁肽联合胰岛素及二甲双胍治疗初诊2型糖尿病能明显改善患者的血清Hcy、CysC、hs-CRP及糖脂代谢水平，临床治疗效果显著，值得推广应用。
      【关键词】 2型糖尿病；初诊；利拉鲁肽；胰岛素；二甲双胍；糖脂代谢；临床疗效
      【中图分类号】 R587.1 【文献标识码】 A 【文章编号】 1003—6350（2022）15—1914—04

Efficacy of liraglutide combined with insulin and metformin in the treatment of newly diagnosed type 2 diabetesand its effect on serum Hcy, CysC, hs-CRP levels and glucose and lipid metabolism.
SHI Min, WANG Qiong, LIWen-juan, LI Xiao-miao. Department of Endocrinology and Metabolism, the First Affiliated Hospital of Air Force MilitaryMedical University, Xi'an 710032, Shaanxi, CHINA
【Abstract】 Objective To explore the curative effect of liraglutide combined with insulin and metformin in thetreatment of newly diagnosed type 2 diabetes and its effects on serum homocysteine (Hcy), cystatin C (Cys C), high sen-sitivity C-reactive protein (hs-CRP) levels and glucose and lipid metabolism. Methods A total of 176 newly diagnosedtype 2 diabetes patients treated in Department of Endocrinology and Metabolism, the First Affiliated Hospital of Air ForceMilitary Medical University from November 2019 to November 2021 were selected as the research objects. According tothe random odd and even number method, the patients were divided into the control group (odd number) and the studygroup (even number), with 88 patients in each group. The control group was treated with insulin and metformin, and thestudy group was treated with liraglutide on the basis of the control group. The clinical effects of the two groups after onemonth of treatment were compared, and the levels of Hcy, CysC, hs-CRP, fasting blood glucose, 2 h postprandial bloodglucose, low density lipoprotein (LDL), total cholesterol (TC), high density lipoprotein (HDL), and triglyceride (TG) be-fore and one month after treatment were compared between the two groups. Results The total effective rate in thestudy group was 96.59%, which was significantly higher than 81.82% in the control group (P<0.05). Before treatment,there were no significant difference in the levels of Hcy, Cys C, and hs-CRP between the two groups (P>0.05). After treat-ment, the levels of Hcy, Cys C, and hs-CRP in the two groups were significantly lower than those before treatment, andthe levels of Hcy, Cys C, and hs-CRP in the study group were (7.40±1.31) μmol/L, (1.35±0.30) mg/L, (2.20±0.27) mg/L,significantly lower than (9.03±1.47) μmol/L, (2.46±0.49) mg/L, (3.38±0.33) mg/L of the control group (P<0.05). Beforetreatment, there were no significant difference in fasting blood glucose, 2 h postprandial blood glucose, LDL, TC, HDLand TG between the two groups (P>0.05). After treatment, the levels of fasting blood glucose, 2 h postprandial blood glu-cose, LDL, TC, and TG in the study group were (6.23±0.41) mmol/L, (8.08±0.74) mmol/L, (2.61±0.44) mmol/L, (3.84±0.70) mmol/L, (1.77±0.23) mmol/L, which were significantly lower than (6.91±0.38) mmol/L, (9.25±0.96) mmol/L,