摘要
目的探讨达格列净与二甲双胍联用对肥胖2型糖尿病患者糖脂代谢、脂肪因子及微小RNA-155(miR-155)/蛋白酪氨酸磷酸酶1B(PTP1B)PTP1B表达的影响。方法前瞻性选取于2021年7月~2024年6月于怀远县中医院就诊的103例肥胖2型糖尿病患者,随机信封法分为A组(吡格列酮+二甲双胍,51例)与B组(达格列净+二甲双胍,52例)。比较两组患者糖脂代谢[总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白/低密度脂蛋白胆固醇(HDL-C/LDL-C)、空腹血糖(FBG)、糖化血红蛋白(HbA1c)、脂肪因子脂联素(ADP)、瘦素(leptin)、内脂素(Visfatin)、厌食神经肽(Nesfatin-1)、miR-155/PTP1B]及肥胖参数[身体质量指数(BMI)、腰臀比、体脂率、内脏脂肪指数(VFI)]。结果治疗后,两组患者HDL-C升高,且B组更高[(1.29±0.21)mmol/L vs.(1.14±0.19)mmol/L];两组患者FBG、HbA1c、TC、LDL-C降低,且B组更低[(7.13±0.89)mmol/L vs.(7.64±1.04)mmol/L、(7.68%±1.05%)vs.(8.14%±1.13%)、(4.54±0.58)mmol/L vs.(5.03±0.67)mmol/L、(2.43±0.47)mmol/L vs.(2.66±0.54)mmol/L],差异均有统计学意义(t=3.799、2.676、2.141、3.971、2.307,P<0.05)。治疗后,两组患者瘦素、内脂素降低,且B组更低[(21.33±4.56)μg/L vs.(28.87±5.13)μg/L、(36.04±7.11)μg/L vs.(45.63±7.56)μg/L],两组患者ADP、Nesfatin-1升高,且B组更高[(7.25±1.57)mg/L vs.(5.46±1.14)mg/L、(2.87±0.71)μg/L vs.(2.24±0.67)μg/L],差异均有统计学意义(t=7.888、6.633、6.610、4.630,P<0.05)。治疗后,B组miR-155上调(0.78±0.16)vs.(0.67±0.14),PTP1B下调更显著(3.05±0.44)μg/L vs.(3.74±0.51)μg/L,差异有统计学意义(t=3.710、7.356,P<0.05)。治疗后,B组BMI(28.04±0.57)kg/m^(2) vs.(28.78±0.74)kg/m^(2)、腰臀比(0.92±0.04)vs.(0.94±0.06)、体脂率(28.79±3.80)vs.(30.41±4.13)、VFI(11.18±1.36)vs.(11.79±1.47)改善更优(t=5.692、1.994、2.072、2.187,P<0.05)。治疗后,两组患者不良反应比较,差异无统计学意义(χ^(2)=0.983,P=322)。结论达格列净联合二甲双胍较吡格列酮联合二甲双胍改善肥胖2型糖尿病患者糖脂代谢,调节脂肪因子、miR-155、PTP1B表达,减少内脏脂肪更优。
Objective To investigate the effects of dapagliflozin combined with metformin on glycolipid metabolism,adipokines,and microRNA-155(miR-155)/protein tyrosine phosphatase 1B(PTP1B)in obese type 2 diabetes mellitus(T2DM)patients.Methods From July 2021 to June 2024,103 obese T2DM patients were prospectively enrolled and randomized into Group A(pioglitazone+metformin,n=51)and Group B(dapagliflozin+metformin,n=52)using an envelope method.Glycolipid parameters[total cholesterol(TC),triglycerides(TG),high-/low-density lipoprotein cholesterol(HDL-C/LDL-C),fasting blood glucose(FBG),HbA1c],adipokines[adiponectin(ADP),leptin,visfatin,nesfatin-1],miR-155/PTP1B,and body composition[BMI,waist-to-hip ratio,body fat%,visceral fat index(VFI)]were analyzed.Results After treatment,Group B showed significant improvements in metabolic parameters compared to Group A.Specifically,Group B had higher levels of HDL-C(1.29±0.21 vs.1.14±0.19 mmol/L),adiponectin(7.25±1.57 vs.5.46±1.14 mg/L),and nesfatin-1(2.87±0.71 vs.2.24±0.67μg/L),while total cholesterol(4.54±0.58 vs.5.03±0.67 mmol/L),LDL-C(2.43±0.47 vs.2.66±0.54 mmol/L),leptin(21.33±4.56 vs.28.87±5.13μg/L),fasting blood glucose(7.13±0.89 vs.7.64±1.04 mmol/L),HbA1c(7.68%±1.05%vs.8.14%±1.13%),and visfatin(36.04±7.11 vs.45.63±7.56μg/L)were significantly lower(all P<0.05).In terms of molecular regulation,Group B exhibited a greater increase in miR-155 expression and a more pronounced reduction in PTP1B levels compared to Group A(P<0.05).Additionally,Group B experienced more marked improvements in body composition,including lower BMI(28.04±0.57 vs.28.78±0.74 kg/m^(2)),waist-to-hip ratio(0.92±0.04 vs.0.94±0.06),body fat percentage(28.79±3.80%vs.30.41±4.13%),and visceral fat index(11.18±1.36 vs.11.79±1.47)(P<0.05).No significant differences were observed between groups in triglyceride levels or adverse events(P>0.05).Conclusion Dagliflozin combined with metformin is superior to pioglitazone combined with metformin in improving glucose-lipid metabolism,regulating adipokine,miR-155,and PTP1B expression,and reducing visceral fat in obese type 2 diabetic patients.
作者
唐宇
白洪超
宋丹
邵飞
Tang Yu;Bai Hongchao;Song Dan;Shao Fei(Department of Endocrinology,Huaiyuan County Traditional Chinese Medicine Hospital,Bengbu 233400,China)
出处
《中华保健医学杂志》
2025年第4期677-681,共5页
Chinese Journal of Health Care and Medicine
基金
安徽省中医药传承创新科研项目(2020zcyb23)。
作者简介
通信作者:唐宇,E-mail:tyhxwh6699@163.com。
