CAJ | 학술논문

目的：观察比较胰高血糖素样肽1（GLP-1）类似物利拉鲁肽以及格列美脲干预治疗2型糖尿病后血糖水平及心血管相关标志物水平变化。方法48例新诊断糖尿病患者，近3个月使用二甲双胍单药治疗达1500 mg且血糖控制不佳的2型糖尿病患者为研究对象，随机分为两组：分别加用利拉鲁肽皮下注射（0.6～1.2 mg/d）或格列美脲（2～4 mg/d）。治疗24周后，观察体重、血压、血糖、血脂改变，超声观察颈动脉内膜中层厚度CIMT变化、同型半胱氨酸（Hcy）、C反应蛋白（CRP）、Ⅰ型血浆纤溶酶原活化抑制剂（PAI-1）、甘露糖结合凝集素（MBL）、基质金属蛋白酶-9（MMP-9）水平。结果与治疗前相比，两组患者治疗后血糖及糖化血红蛋白（HbA1c）水平均显著降低（P＜0.01或P＜0.05），但两组间无显著性差异。利拉鲁肽组体重较治疗前减轻，而格列美脲组无明显变化。两组患者收缩压及舒张压均有下降，但无统计学意义（P＞0.05）。两组Hcy、CRP、PAI-1、MBL、MMP-9等血浆心血管标志物下降，但利拉鲁肽组明显优于格列美脲组（P＜0.01）。结论利拉鲁肽降糖效果与格列美脲相当，但其可有效降低体重并影响心血管相关危险因素水平，对心血管可能具有保护作用。
목적：관찰비교이고혈당소양태1（GLP-1）유사물리랍로태이급격렬미뇨간예치료2형당뇨병후혈당수평급심혈관상관표지물수평변화。방법48례신진단당뇨병환자，근3개월사용이갑쌍고단약치료체1500 mg차혈당공제불가적2형당뇨병환자위연구대상，수궤분위량조：분별가용리랍로태피하주사（0.6～1.2 mg/d）혹격렬미뇨（2～4 mg/d）。치료24주후，관찰체중、혈압、혈당、혈지개변，초성관찰경동맥내막중층후도CIMT변화、동형반광안산（Hcy）、C반응단백（CRP）、Ⅰ형혈장섬용매원활화억제제（PAI-1）、감로당결합응집소（MBL）、기질금속단백매-9（MMP-9）수평。결과여치료전상비，량조환자치료후혈당급당화혈홍단백（HbA1c）수평균현저강저（P＜0.01혹P＜0.05），단량조간무현저성차이。리랍로태조체중교치료전감경，이격렬미뇨조무명현변화。량조환자수축압급서장압균유하강，단무통계학의의（P＞0.05）。량조Hcy、CRP、PAI-1、MBL、MMP-9등혈장심혈관표지물하강，단리랍로태조명현우우격렬미뇨조（P＜0.01）。결론리랍로태강당효과여격렬미뇨상당，단기가유효강저체중병영향심혈관상관위험인소수평，대심혈관가능구유보호작용。
Objective To investigate the levels of markers for cardiovascular disease in type 2 diabetes mellitus and the effect of glimepiride and liraglutide which is a long-acting human glucagon-like peptide-1 (GLP-1) analog on these markers. Methods This study included 48 T2DM patients had been treated with poorly controlled diabetes using metformin (1 500 mg) in the latest 3 months. The patients were randomly divided into the treatment groups of glimepiride (2-4 mg/d) or liraglutide (0.6-1.2 mg/d) for 24 weeks. The body weight, blood pressure, glucose, lipids and the markers for cardiovascular disease including serum C-reactive protein (CRP), plasminogen activator inhibitor type-1 (PAI-1), mannose binding lectin (MBL), serum matrix metalloproteinase-9 (MMP-9), homocysteine (Hcy) and carotid intima media thickness (CIMT) were detected at the 24 weeks after the patients being treated. Results The level of blood sugar and HbA1c decreased in both groups (P<0.01 or P<0.05) after treatment, but there was no significant difference between two groups (P>0.05). Significant average weight loss compared with baseline was seen in liraglutide group (P<0.01), while there was no significant improvement in glimepiride group (P>0.05). The levels of Hcy, CRP, PAI-1, MBL, MMP-9 were dramatically reduced after administration of liraglutide and glimepiride group, but the effect of liraglutide was significantly superior to glimepiride (P<0.01). Conclusion Liraglutide had similar blood glucose lowering effect as glimepiride. Liraglutide decreases body weight effectively and have protective effect on macrovascular diseases through inhibition of theses markers.