摘要
目的观察不同减重方式对2型糖尿病肥胖患者内脏脂肪含量、血糖控制及分泌型卷曲相关蛋白5(secretory curl related protein 5,SFRP5)、脂联素(adiponectin,APN)、瘦素(leptin,LP)的调节作用,以期寻找一种更适合于糖尿病合并肥胖人群的减重、降糖模式。方法选取2018-06/2020-12月作者医院2型糖尿病肥胖患者195例,以随机数字表法分为试验A组、试验B组、试验C组、试验D组、对照组,每组各39例。试验A组给予限制热量平衡饮食,试验B组给予正常热量饮食联合口服二甲双胍、试验C组给予正常热量饮食联合口服奥利司他、试验D组给予正常热量饮食联合利拉鲁肽,对照组给予正常热量饮食,均治疗3个月。比较5组治疗前、治疗3个月后体质量、体质量指数(body mass index,BMI)、腰围、内脏脂肪含量、糖化血红蛋白(haemoglobin A1c,HbA1c)、空腹血糖(fasting blood glucose,FPG)、餐后2 h血糖(postprandial 2-hour blood glucose,2hPG)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)、总胆固醇(total cholesterol,TC)、甘油三酯(triglycerides,TG)、稳态模型胰岛素抵抗指数(homeostatic model assessment for insulin resistance,HOMA-IR)、稳态模型胰岛β细胞功能指数(homeostatic model assessment ofβ-cell function,HOMA-β)、SFRP5、APN、LP水平。结果治疗3个月后,(1)患者体质量、BMI、腰围、内脏脂肪含量组间比较,试验C组<试验D组<试验B组<试验A组<对照组(P<0.05);(2)HbA1c、FPG、2hPG水平组间比较,试验B组和试验D组<试验C组<试验A组<对照组(P<0.05);(3)LDL-C、TC、TG水平组间比较,试验C组<试验D组<试验B组<试验A组<对照组(P<0.05),HDL-C水平的组间比较,试验C组>试验D组>试验B组>试验A组>对照组(P<0.05);(4)HOMA-IR、HOMA-β水平组间比较,试验B组和试验D组<试验C组<试验A组<对照组(P<0.05);(5)血清SFRP5水平组间比较,试验D组>试验C组>试验B组>试验A组>对照组(P<0.05),APN水平组间比较,试验C组>试验D组>试验B组>试验A组>对照组(P<0.05),LP水平组间比较,试验C组<试验D组<试验B组<试验A组<对照组(P<0.05)。结论2型糖尿病肥胖患者采用二甲双胍、利拉鲁肽治疗降糖、调节胰岛素敏感性作用显著,采用奥利司他治疗减重、降脂效果显著,还可调节SFRP5、APN、LP表达水平,减轻LP抵抗状态,加速脂肪分解及糖代谢。
Objective To observe the regulatory effects of different weight loss methods on visceral fat content,blood sugar control and secretory curl related protein 5(SFRP5),adiponectin(APN)and leptin(LP)in obese patients with diabetes,so as to find a more suitable lose weight and hypoglycemic mode for obese patients with diabetic mellitus.Methods A total of 195 obese patients with type 2 diabetes mellitus in author′s hospital from June 2018 to December 2020 were divided into study A group,study B group,study C group,study D group and control group by random number table,with 39 cases in each.Study A group was given a balanced calorie diet,group B was given a normal calorie diet combined oral metformin,group C was given a normal calorie diet combined oral orlistat,group D was given a normal calorie diet combined liraglutide,and the control group was given the normal calorie diet,with treatment for 3 months in each.The levels of body mass,body mass index(BMI),waist circumference,visceral fat content,haemoglobin A_(1c)(HbA_(1c)),fasting blood glucose(FPG),postprandial 2-hour blood glucose(2hPG),high-density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),total cholesterol(TC),triglycerides(TG),homeostatic model assessment for insulin resistance(HOMA-IR),homeostatic model assessment ofβ-cell function(HOMA-β),SFRP5,APN and LP in the 5 groups were compared before treatments and 3 months after treatments.Results After 3 months of treatments,(1)Body mass,BMI,waist circumference and visceral fat content of patients among groups were compared,study C group study D group study B groupstudy A groupcontrol group(P<0.05);(2)The levels of HbA_1c,FPG and 2hPG among groups were compared,study B group and study D groupstudy C group study A group control group(P<0.05);(3)The levels of LDL-C,TC and TG among groups were compared,study C groupstudy D groupstudy B group study A group control group(P<0.05),the levels of HDL-C among groups were compared,study C group study D groupstudy B groupstudy A groupcontrol group(P<0.05);(4)The levels of HOMA-IR and HOMA-βamong groups were compared,study B group and study D groupstudy C groupstudy A group control group(P<0.05);(5)The levels of serum SFRP5 among groups were compared,study D groupstudy C groupstudy B groupstudy A groupcontrol group(P<0.05),and the levels of APN among groups were compared,study C group study D group study B group study A group control group(P<0.05),the levels of LP among groups were compared,study C group study D group study B group study A group control group(P<0.05).Conclusion To obese patients with type 2 diabetes mellitus,metformin and liraglutide have significant effects on hypoglycemic and insulin sensitivity regulation,while orlistat has a significant effect on weight loss and lipid lowering,as well as regulating the expression levels of SFRP5,APN and LP,reducing LP resistance,accelerating fat breakdown and glucose metabolism.
作者
黎俊森
刘丹
黎培爱
崔静
LI Junsen;LIU Dan;LI Peiai;CUI Jing(Department of Endocrinology,Sanya Central Hospital(Hainan Province Third People's Hospital),Sanya Hainan 572000,China)
出处
《联勤军事医学》
CAS
2023年第6期477-482,共6页
Military Medicine of Joint Logistics
基金
海南省卫生健康行业科研项目(20A200372)。
关键词
减重方式
肥胖症
2型糖尿病
内脏脂肪含量
血糖控制
脂联素
分泌型卷曲相关蛋白5
瘦素
Weight loss method
Obesity
Type 2 diabetes mellitus
Visceral fat content
Blood glucose control
Adiponectin
Secretory curl related protein 5
Leptin
