兰索拉唑与艾塞那肽联用对2型糖尿病患者胃泌素及胃泌酸调节素的影响

doi:10.6040/j.issn.1671-7554.0.2015.338

摘要/Abstract

摘要： 目的观察2型糖尿病(T2DM)患者经艾塞那肽联合兰索拉唑治疗前后糖脂代谢、体成份、胰岛素敏感性的变化;探讨兰索拉唑对T2DM患者血清胃泌素(Gastrin)、胃泌酸调节素(OXM)水平的影响.方法选取肥胖T2DM患者54例,随机分为联合用药组(n=27)和艾塞那肽组(n=27),联合用药组治疗方案:原有降糖基础上应用艾塞那肽10 μg,早晚餐前1 h皮下注射,联合兰索拉唑15 mg,早1片治疗;艾塞那肽组治疗方案:原有降糖基础上应用艾塞那肽10 μg,早晚餐前1 h皮下注射治疗.8周后观察体质量、体成份、血压、空腹血糖(FBG)、血脂、肝肾功、空腹胰岛素、糖化血红蛋白(HbA1c)、胰岛素抵抗指数(HOMA-IR)、Gastrin、OXM等指标的变化.结果两组患者体质量、体成份、低密度脂蛋白(LDL)、FBG、HbA1c、HOMA-IR、收缩压均较治疗前明显下降(P<0.05).联合用药组胃肠道不良反应较艾塞那肽组减少,Gastrin水平明显升高[(160.76±8.93) vs (95.30±6.01)ng/L, P<0.05],FBG水平[(8.06±2.33) vs (8.51±2.71)mmol/L, P<0.05]、HbA1c水平[(7.79±0.78)% vs (7.87±0.81)%, P<0.05]均低于艾塞那肽组.兰索拉唑治疗前后两组ALT、AST、尿酸(UA)、血肌酐(Scr)、血尿氮(BUN)、高密度脂蛋白(HDL)、OXM等水平差异无统计学意义(P>0.05).相关分析显示艾塞那肽联用兰索拉唑后,Gastrin升高与其HbA1c下降相关(r=-0.302,P<0.05).结论兰索拉唑能改善T2DM患者早期应用艾塞那肽后引起的胃肠道反应,有助于空腹血糖的控制,其作用可能与兰索拉唑提高血清Gastrin水平有关;兰索拉唑对患者血清OXM的变化无明显影响.

关键词: 艾塞那肽, 兰索拉唑, 2型糖尿病, 胃泌素

Abstract: Objective To observe glucose and lipids levels, body composition and insulin sensitivity before and after the treatment of exenatide and lansoprazole in type 2 diabetes mellitus (T2DM) patients, and to explore the effects of lansoprazole on the serum gastrin and oxyntomodulin (OXM). Methods Fifty-four obese patients with T2DM were randomly divided into combined treatment group (n=27) and exenatide group (n=27). Therapeutic plan of combined treatment group: 10 μg exenatide (subcutaneous injection one hour before breakfast and dinner) plus 15 mg lansoprazole were applied based on the original scheme; therapeutic plan of exenatide group: 10 μg exenatide (subcutaneous injection one hour before breakfast and dinner) was applied based on the original scheme. After 8 weeks of treatment, the changes in weight, body composition, blood pressure, fasting blood glucose (FBG), serum lipids, hepatic and renal functions, fasting insulin, glycosylated hemoglobin (HbA1c), insulin resistance index (HOMA-IR), serum gastrin and OXM were measured. Results Body weight, body composition, low densith lipoprotein (LDL), FBG, HbA1c, HOMA-IR and systolic pressure decreased significantly after treatment in both two groups (P<0.05). Comapred withexenatide group, gastrointestinal discomfort was alleviated, serum gastrin level increased [(160.76±8.93) vs (95.30±6.01) ng/L, P<0.05], FBG [(8.06±2.33) vs (8.51±2.71)mmol/L, P<0.05] and HbA1c[(7.79±0.78) vs (7.87±0.81)%, P<0.05] levels decresed in combined treatment group. The changes of ALT, AST, uric acid (UA), serum creatinine (Scr), blood urine nitrogen (BUN), high density lipoprotein (HDL) and OXM in two groups had no statistical differences (P>0.05). Correlation regression analysis showed that the decrease of HbA1c was associated with the increase of gastrin after treatment of exenatide and lansoprazole(r=-0.302, P<0.05). Conclusion Lansoprazole can alleviate gastrointestinal discomfort caused by exenatide in the early stage and reduce the blood glucose levels in obese T2DM patients, which may be related to the increase of gastrin. However, lansoprazole may have not any effects in the changes of oxyntomodulin.

Key words: Type 2 diabetes mellitus, Exenatide, Lansoprazole, Gastrin

中图分类号:

R589

李寒冰, 高燕燕, 李莉, 曹彩霞, 咸玉欣, 王静, 牛佳鹏. 兰索拉唑与艾塞那肽联用对2型糖尿病患者胃泌素及胃泌酸调节素的影响[J]. 山东大学学报（医学版）, 2015, 53(11): 64-68.

LI Hanbing, GAO Yanyan, LI Li, CAO Caixia, XIAN Yuxin, WANG Jing, NIU Jiapeng. Effect of lansoprazole and exenatide on gastrin and oxyntomodulin in patients with type 2 diabetes[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2015, 53(11): 64-68.

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