摘要
目的探究胰高血糖素样肽-1受体激动剂(glucagon like peptide-1 receptor agonists,GLP-1RA)类药物利拉鲁肽和司美格鲁肽致2型糖尿病(T2DM)患者胃肠道不良反应及其影响因素。方法选择2023年1月至2024年6月在河北省邢台市人民医院内分泌科进行诊治的228例T2DM患者作为研究对象,观察和记录使用利拉鲁肽和司美格鲁肽治疗期间患者的胃肠道不良反应,将患者按照是否发生胃肠道不良反应分为胃肠道组和非胃肠道组,比较两组临床资料差异,使用Logistic回归分析方程分析T2DM患者胃肠道不良反应的影响因素。结果75例(32.89%)患者在用药期间描述存在胃肠道不良反应,总发生245例次,其中恶心93例次(37.96%),腹泻50例次(20.41%),呕吐46例次(18.78%),腹部不适37例次(15.10%),便秘19例次(7.76%)。使用利拉鲁肽和司美格鲁肽治疗的患者胃肠道不良反应发生次数和严重程度差异均无统计学意义(均P>0.05)。胃肠道组患者女性比例、年龄、身体质量指数(BMI)、T2DM病程、GLP-1RA用药剂量、胃肠道疾病史占比、合并服用其他药物数量均高于非胃肠道组,舒张压(DBP)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、丙氨酸氨基转移酶(ALT)、估算肾小球滤过率(eGFR)、总胆红素(TBIL)、尿酸(UA)低于非胃肠道组,差异均有统计学意义(P<0.05)。BMI升高是T2DM患者发生胃肠道不良反应的保护因素(OR=0.520,P=0.003),女性、年龄≥60岁、GLP-1RA用药剂量升高、有胃肠道疾病史、T2DM病程≥2年、合并服用其他药物数量>1种是T2DM患者发生胃肠道不良反应的危险因素(OR=2.858、1.055、2.008、4.909、2.179、1.933,均P<0.05)。结论T2DM患者使用GLP-1RA药物治疗具有胃肠道不良反应风险,BMI升高是胃肠道不良反应的保护因素,女性、年龄≥60岁、GLP-1RA用药剂量升高、有胃肠道疾病史、T2DM病程较长、合并服用其他药物是危险因素。对于符合上述条件的患者,应当更为谨慎地用药,并根据患者症状及时调整干预策略。
Objective To explore the influencing factors for gastrointestinal adverse reactions in patients with glucagon-like peptide-1 receptor agonist(GLP-1RA)drugs liraglutide and simegallutide for type 2 diabetes mellitus(T2DM).Methods A total of 228 patients with T2DM who were treated in the Department of Endocrinology of Xingtai People’s Hospital in Hebei Province from January 2023 to June 2024 were selected as the study subjects,and the gastrointestinal adverse reactions of the patients were observed and recorded during the treatment with liraglutide and simethicone,and patients were divided into the gastrointestinal adverse reaction group and the non-gastrointestinal adverse reaction group according to whether or not they had gastrointestinal adverse reactions.The differences in the clinical data between the two groups were compared,and the influencing factors affecting the gastrointestinal adverse reactions of T2DM patients were analyzed using Logistic regression analysis equation.Results A total of 75 patients(32.89%)described the presence of gastrointestinal adverse reactions during the medication period,and the total number of occurrences was 245 case-times.The highest number of nausea occurred in 93 case-times(37.96%),followed by 50 case-times of diarrhea(20.41%),46 case-times of vomiting(18.78%),and 37 case-times of abdominal discomfort(15.10%),and the lowest number of constipation occurred in 19 casetimes(7.76%).There were no statistically significant differences in the frequency and severity of gastrointestinal adverse reactions between the patients treated with liraglutide and those treated with semaglutide(P>0.05).The proportion of female patients,age,BMI,duration of T2DM,dose of GLP-1RA,percentage of history of gastrointestinal disease,and number of other medications taken in combination were higher in the gastrointestinal ADR group than in the non-gastrointestinal ADR group,and diastolic blood pressure(DBP),free triiodothyronine(FT3),free thyroxin(FT4),alanine aminotransferase(ALT),estimated glomerular filtration rate(eGFR),total bilirubin(TBIL),and uric acid(UA)were lower than those in the non-gastrointestinal ADR group,and the differences were statistically significant(P<0.05).Elevated BMI was a protective factor for the occurrence of gastrointestinal adverse reactions in patients with T2DM(OR=0.520,P=0.003),and female gender,no less than 60 years of age,increased dosage of GLP-1RA,history of gastrointestinal disorders,duration of T2DM of greater than or equal to 2 years,and the number of co-administered other medications of greater than 1 were risk factors for the occurrence of gastrointestinal adverse reactions in patients with T2DM(OR=2.858,1.055,2.008,4.909,2.179,1.933,all P<0.05).Conclusion The T2DM patients who are treated with GLP-1RA have a risk of gastrointestinal adverse effects,elevated BMI was a protective factor for gastrointestinal adverse effects,female gender,age 60 years,increased dose of GLP-1RA,history of gastrointestinal disease,long disease course of T2DM,and combination of other drugs are the risk factors.For patients meeting the above conditions,medication should be more cautious and intervention strategies should be adjusted according to their symptoms.
作者
李雅然
赵慧敏
张燕青
张健
田晓鹏
Li Yaran;Zhao Huimin;Zhang Yanqing;Zhang Jian;Tian Xiaopeng(Department of Endocrinology,Xingtai People’s Hospital,Xingtai 054000,China;Department of Gastroenterology,Xingtai People’s Hospital,Xingtai 054000,China)
出处
《中国药物应用与监测》
2025年第3期552-557,共6页
Chinese Journal of Drug Application and Monitoring
基金
邢台市重点研发计划项目(2022ZC214)。
关键词
胰高血糖素样肽-1受体激动剂
2型糖尿病
胃肠道
不良反应
影响因素
Glucagon like peptide-1 receptor agonists
Type 2 diabetes mellitus
Gastrointestinal tract
Adverse reaction
Influencing factors
作者简介
通信作者:赵慧敏,Email:huiminzhaoa@163.com。
