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山东大学学报 (医学版) ›› 2019, Vol. 57 ›› Issue (6): 87-93.doi: 10.6040/j.issn.1671-7554.0.2019.253

• • 上一篇    

达格列净改善超重及肥胖2型糖尿病患者脂代谢及内脏脂肪含量

姜立娟,刘福强,蒋子允,李文娟,林鹏,王川,侯新国,陈丽   

  1. 山东大学齐鲁医院内分泌科, 山东 济南 250012
  • 发布日期:2022-09-27
  • 通讯作者: 陈丽. E-mail:chenli3@medmail.com.cn
  • 基金资助:
    国家重点研发计划(2018YFC1311800)

Dapagliflozin improves lipid metabolism and visceral adipose tissues in overweight and obese patients with type 2 diabetes

JIANG Lijuan, LIU Fuqiang, JIANG Ziyun, LI Wenjuan, LIN Peng, WANG Chuan, HOU Xinguo, CHEN Li   

  1. Department of Endocrinology, Qilu Hospital of Shandong University, Jinan 250012, Shandong, China
  • Published:2022-09-27

摘要: 目的 评价钠-葡萄糖协同转运蛋白-2(SGLT-2)抑制剂对超重及肥胖2型糖尿病患者的各项体脂参数的影响,探究其对脂代谢及内脏脂肪的影响及可能机制。 方法 随机选取入院前血糖控制不佳的2型糖尿病住院患者60例,男46例,女14例,35~65岁,平均50岁。随机分为对照组和达格列净(安达唐)治疗组,每组30例。两组均进行糖尿病教育,对照组调整胰岛素或口服降糖药方案或联用非SGLT-2抑制剂,治疗组在原有口服降糖药和或胰岛素治疗基础上加用达格列净,1次/d,10 mg/次,共12周。记录两组年龄、性别、血糖、糖化血红蛋白、血脂指标、体成分基线值及治疗12周后值,达格列净治疗组24 h尿糖定量及电解质,血生化指标的基线值及治疗12周后值,同时记录两组治疗期间不良反应的发生率包括尿路感染、生殖道感染、低血糖及肾功能异常。 结果 两组性别比例、年龄、血糖、糖化血红蛋白、体质量等基线值差异无统计学意义(P>0.05)。12周治疗后,两组血糖均得到有效控制(P<0.01)。在血脂参数中,达格列净显著降低甘油三酯(P<0.05),增加高密度脂蛋白(P<0.01),对胆固醇及低密度脂蛋白无显著影响(P>0.05)。对照组在治疗期内血脂无明显变化(P>0.05)。治疗期间内达格列净显著降低患者内脏脂肪面积内脏脂肪量(P<0.01),对体质量全身脂肪百分比四肢骨骼肌指数骨矿含量等身体成分无显著影响(P>0.05);同时达格列净治疗组24 h尿糖定量显著增加(P<0.01),24 h尿液中电解质无显著差异(P>0.05),对血电解质血常规及肾功也无影响(P>0.05)。治疗期内,达格列净治疗组不良反应与对照组差异无统计学意义(P>0.05)。 结论 达格列净显著降低2型糖尿病的血糖值,并且显著降低糖尿病患者的甘油三酯、内脏脂肪面积、内脏脂肪量,增加高密度脂蛋白,降低心血管疾病的危险因素,且对肾功、电解质均无显著影响,不增加肾功能损害及低血糖的发生率,是一种安全有效的治疗药物。

关键词: 钠-葡萄糖协同转运蛋白-2抑制剂, 2型糖尿病, 血糖, 脂代谢, 体成分

Abstract: Objective To evaluate the effects of sodium-glucose cotransporter protein 2(SGLT-2)inhibitor, dapagliflozin, on various body fat parameters in overweight and obese patients with type 2 diabetes, and to explore its effects on lipid metabolism and visceral adipose tissues and the potential mechanism. Methods A total of 60 hospitalized patients with type 2 diabetes who had poor blood glucose control before admission were randomly selected, including 46 males and 14 females, aged 35-65 years, average 50 years. The patients were randomly divided into control group(n=30)and dapagliflozin(Adatang)treatment group(n=30). Diabetes education was conducted in both groups. In the control group, insulin, oral antidiabetic drugs or combination medication with non-SGLT2 inhibitors were adjusted. In the dapagliflozin treatment group, 10 mg/d dapagliflozin was combined with prior insulin or oral antidiabetic drugs for 山 东 大 学 学 报 (医 学 版)57卷6期 -姜立娟,等.达格列净改善超重及肥胖2型糖尿病患者脂代谢及内脏脂肪含量 \=-12 weeks. Parameters were recorded, including age, sex, blood glucose, glycosylated hemoglobin, blood lipid, baseline and post-treatment body composition in both groups; 24 h glycosuria quantitative and electrolytes, baseline and post-treatment blood biochemical indicators in the dapagliflozin treatment group. The incidence of adverse reactions such as urinary tract infection, genital tract infection, hypoglycemia and abnormal renal function in both groups were recorded. Results There were no statistical differences in age, sex, baseline values of glycosylated hemoglobin and body weight between the two groups(P>0.05). After 12 weeks of treatment, blood glucose was effectively controlled in both groups(P<0.01). In terms of lipid parameters, dapagliflozin significantly reduced triglyceride(P<0.05)and increased high-density lipoprotein(P<0.01), but had no significant effects on cholesterol or low-density lipoprotein(P>0.05). There was no significant change in blood lipid in the control group(P>0.05). Dapagliflozin significantly reduced the area and mass of visceral adipose tissues(P<0.01), but had no significant effects on body mass, percentage of body fat, skeletal muscle index of limbs, and bone mineral content(P>0.05). Moreover, there was a significant increase in 24 h glycosuria quantitative in the dapagliflozin treatment group(P<0.01), but no significant difference in 24 h urine electrolytes, blood electrolytes, blood routine and renal function(P>0.05). During the treatment, there was no significant difference in adverse reactions between the two groups(P>0.05). Conclusion Dapagliflozin can significantly reduce blood glucose, triglycerides, and area and mass of visceral adipose tissues in patients with type 2 diabetes, while increase high-density lipoprotein. It can reduce the risk of cardiovascular diseases, but at the same time it has no significant effects on renal function and electrolytes. It does not increase the incidence of renal impairment and hypoglycemia. Dapagliflozin is safe and effective for patients with type 2 diabetes.

Key words: sodium-glucose cotransporter protein 2 inhibitor, Type 2 diabetes, Blood glucose, Lipid metabolism, Body composition

中图分类号: 

  • R587.1
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