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目的观察利拉鲁肽与二甲双胍对肥胖T2DM患者血清趋化素(Chemerin)、内脂素(Visfatin)水平的影响,分析影响其下降的因素。方法72例肥胖T2DM患者随机分为二甲双胍(Met)组36例(赖脯胰岛素50联合二甲双胍1.5~2.0 g/d)和利拉鲁肽(Lir)组36例(赖脯胰岛素50联合利拉鲁肽1.2~1.8 mg/d皮下注射),疗程16周。结果两组治疗后FPG、2 hPG、TG、HbA_1c、HOMA-IR、血清Chemerin、Visfatin水平均较治疗前降低(P<0.05或P<0.01);Lir组LDL-C、WC、BMI较治疗前亦有下降(P<0.05)。两组△WC、△BMI、△LDL-C、△HOMA-IR、△胰岛素用量比较,差异有统计学意义(P<0.05或P<0.01)。Lit组较Met组血清Chemerin[(16.94±14.40)vs(6.45±9.64)μg/L,P<0.01]和Visfatin[(10.18±12.64)vs(6.75±10.02)μg/L,P<0.05]下降幅度更大。相关分析显示,△血清Chemerin与△WC、△HbA_1c、△HOMA-IR呈正相关(P<0.05,P<0.01);AVisfatin与△WC、△HOMA-IR呈正相关(P<0.05)。多元逐步回归分析显示,Lir组影响△血清Chemerin的重要因素为△WC、△BMI(t=4.342,P<0.01;t=3.019,P<0.05),Met组为△WC(t=2.348,P<0.05);两组影响△Visfatin的重要因素均为△WC(t=2.327、3.113,P均<0.05)。结论Lir降低血清Chemerin、Visfatin水平更显著可能与其改善WC力度更大有关。
Objective To observe the effects of liraglutide and metformin on serum Chemerin and visfatin levels in obese T2DM patients and analyze the factors influencing their decline. Methods Seventy-two patients with obese T2DM were randomly divided into 36 patients (metformin with insulin lispro 50 and metformin 1.5-2.0 g / d) and 36 patients with liulutide (insulin lispro 50 combined with liraglutide Peptide 1.2 ~ 1.8 mg / d subcutaneous injection) for 16 weeks. Results The levels of FPG, 2 hPG, TG, HbA 1c, HOMA-IR, Chemerin and Visfatin in both groups were significantly lower than those before treatment (P <0.05 or P <0.01) Also decreased (P <0.05). The differences of △ WC, △ BMI, △ LDL-C, △ HOMA-IR and △ insulin between the two groups were statistically significant (P <0.05 or P <0.01). The levels of serum Chemerin (16.94 ± 14.40 vs 6.45 ± 9.64 μg / L, P <0.01) and Visfatin [(10.18 ± 12.64) vs (6.75 ± 10.02) μg / L, P <0.05] Magnitude. Correlation analysis showed that serum Chemerin was positively correlated with △ WC, △ HbA_1c and △ HOMA-IR (P <0.05, P <0.01). AVisfatin was positively correlated with △ WC and △ HOMA-IR (P <0.05). Multivariate stepwise regression analysis showed that the important factors affecting the serum Chemerin in △ Lir group were △ WC and △ BMI (t = 4.342, P <0.01; t = 3.019, P < <0.05). The two important factors affecting △ Visfatin were △ WC (t = 2.327, 3.133, P <0.05). Conclusions Lir decreased serum Chemerin, Visfatin more significant levels may be associated with its efforts to improve WC more.