论文部分内容阅读
目的观察2型糖尿病(T2DM)患者经艾塞那肽联合兰索拉唑治疗前后糖脂代谢、体成份、胰岛素敏感性的变化;探讨兰索拉唑对T2DM患者血清胃泌素(Gastrin)、胃泌酸调节素(OXM)水平的影响。方法选取肥胖T2DM患者54例,随机分为联合用药组(n=27)和艾塞那肽组(n=27),联合用药组治疗方案:原有降糖基础上应用艾塞那肽10μg,早晚餐前1 h皮下注射,联合兰索拉唑15 mg,早1片治疗;艾塞那肽组治疗方案:原有降糖基础上应用艾塞那肽10μg,早晚餐前1 h皮下注射治疗。8周后观察体质量、体成份、血压、空腹血糖(FBG)、血脂、肝肾功、空腹胰岛素、糖化血红蛋白(Hb A1c)、胰岛素抵抗指数(HOMA-IR)、Gastrin、OXM等指标的变化。结果两组患者体质量、体成份、低密度脂蛋白(LDL)、FBG、Hb A1c、HOMA-IR、收缩压均较治疗前明显下降(P<0.05)。联合用药组胃肠道不良反应较艾塞那肽组减少,Gastrin水平明显升高[(160.76±8.93)vs(95.30±6.01)ng/L,P<0.05],FBG水平[(8.06±2.33)vs(8.51±2.71)mmol/L,P<0.05]、Hb A1c水平[(7.79±0.78)%vs(7.87±0.81)%,P<0.05]均低于艾塞那肽组。兰索拉唑治疗前后两组ALT、AST、尿酸(UA)、血肌酐(Scr)、血尿氮(BUN)、高密度脂蛋白(HDL)、OXM等水平差异无统计学意义(P>0.05)。相关分析显示艾塞那肽联用兰索拉唑后,Gastrin升高与其Hb A1c下降相关(r=-0.302,P<0.05)。结论兰索拉唑能改善T2DM患者早期应用艾塞那肽后引起的胃肠道反应,有助于空腹血糖的控制,其作用可能与兰索拉唑提高血清Gastrin水平有关;兰索拉唑对患者血清OXM的变化无明显影响。
Objective To observe the changes of glucose and lipid metabolism, body composition and insulin sensitivity before and after treatment with exenatide and lansoprazole in patients with type 2 diabetes mellitus (T2DM). To investigate the effect of lansoprazole on serum gastrin, Effects of oxyntomodulin (OXM) levels. Methods Fifty-four patients with obesity T2DM were randomly divided into combined treatment group (n = 27) and exenatide group (n = 27). The combination therapy group was given exenatide 10μg, 1 h before breakfast and dinner subcutaneously, combined with lansoprazole 15 mg, as early as 1 treatment; exenatide group treatment options: the original application of exenatide on the basis of hypoglycemic 10μg, 1h before and after meals, subcutaneous injection therapy . After 8 weeks, the changes of body weight, body composition, blood pressure, fasting blood glucose (FBG), blood lipid, liver and kidney function, fasting insulin, HbA1c, HOMA-IR, Gastrin and OXM were observed . Results The body weight, body composition, LDL, FBG, Hb A1c, HOMA-IR and systolic blood pressure were significantly decreased in both groups (P <0.05). Gastrointestinal adverse reactions in combination group decreased compared with that in exenatide group, Gastrin level increased significantly ([(160.76 ± 8.93) vs (95.30 ± 6.01) ng / L, P <0.05] vs (8.51 ± 2.71) mmol / L, P <0.05]. The level of Hb A1c was significantly lower than that of exenatide group [(7.79 ± 0.78)% vs (7.87 ± 0.81)%, P <0.05] There was no significant difference in the levels of ALT, AST, UA, Scr, BUN, HDL and OXM before and after treatment with lansoprazole (P> 0.05) . Correlation analysis showed that increased excretion of Gastrin correlated with decreased Hb A1c after exenatide plus lansoprazole (r = -0.302, P <0.05). Conclusions Lansoprazole can improve the gastrointestinal reaction induced by exenatide in early stage of T2DM patients, which is helpful to the control of fasting blood glucose, which may be related to the increase of serum Gastrin level of lansoprazole. The change of serum OXM had no significant effect.