达格列净联合二甲双胍在肥胖/超重型T2DM中的应用及对肠道微生态、adropin、chemerin、irisin的影响

doi:10.3969/j.issn.1007-3205.2021.11.006

河北医科大学学报 ›› 2021, Vol. 42 ›› Issue (11): 1266-1271.doi: 10.3969/j.issn.1007-3205.2021.11.006

达格列净联合二甲双胍在肥胖/超重型T2DM中的应用及对肠道微生态、adropin、chemerin、irisin的影响

河北省保定市第二医院内分泌科，河北保定 071000

出版日期:2021-11-25 发布日期:2021-11-29
作者简介:李丽莉（1984-），女，河北易县人，河北省保定市第二医院主治医师，医学硕士，从事内分泌科疾病诊治研究。
基金资助:
河北省医学科学研究课题计划（20181568）

Application of dapagliflozin combined with metformin in obese/overweight T2DM and its effect on intestinal microbiota, adropin, chemerin, and irisin

Department of Endocrinology, the Second Hospital of Baoding City, Hebei Province, Baoding 071000， China

Online:2021-11-25 Published:2021-11-29

摘要/Abstract

摘要： 目的探讨达格列净联合二甲双胍在肥胖/超重型2型糖尿病（type 2 diabetes mellitus，T2DM）中的应用效果及对肠道微生态、能量平衡相关蛋白（adropin）、趋化素（chemerin）、鸢尾素（irisin）的影响。
方法按照电脑随机数字表法，按1∶1原则将112例肥胖/超重型T2DM患者分为两组，各56例。对照组给予二甲双胍治疗，观察组给予达格列净联合二甲双胍治疗。比较两组血糖水平［空腹血糖（fasting plasma glucose，FPG）、餐后2 h血糖（postprandial two-hour plasma glucose，2 hPG）、糖化血红蛋白（hemoglobin A1c，HbA1c）］、稳态模型胰岛素抵抗指数（homeostasis model assessment，HOMA-IR）、腰围、体质量指数（body mass index，BMI）、血脂指标［高密度脂蛋白胆固醇（high density lipoprotein cholesterol，HDL-C）、三酰甘油（triglycerides，TG）、低密度脂蛋白胆固醇（low density lipoprotein cholesterol，LDL-C）、总胆固醇（total cholesterol，TC）］、肠道微生态、adropin、chemerin、irisin水平及不良反应。
结果观察组治疗后3个月、6个月FPG、2 hPG、HbA1c、HOMA-IR低于对照组（P＜0.05）；观察组治疗6个月后腰围、BMI低于对照组（P＜0.05）；观察组治疗3、6个月后TG低于对照组，HDL-C高于对照组（P＜0.05）；观察组治疗6个月后肠球菌、肠杆菌数量低于对照组，拟杆菌、乳酸杆菌数量高于对照组（P＜0.05）；观察组治疗3、6个月后adropin、irisin高于对照组，chemerin低于对照组（P＜0.05）。
结论达格列净联合二甲双胍治疗肥胖/超重型T2DM，可有效降低血糖水平，改善胰岛素抵抗、血脂代谢及肠道微生态，缓解肥胖/超重，安全性高，降低chemerin，提高adropin、irisin可能是两者联合发挥抗T2DM效应的一个分子水平机制。

关键词: 糖尿病, 2型, 达格列净, 二甲双胍

Abstract: Objective To investigate the application effect of dapagliflozin combined with metformin in obese/overweight type 2 diabetes mellitus(T2DM) and its effect on intestinal microbiota, adropin, chemerin, and irisin.
Methods According to the computerized random number table method, 112 obese/overweight T2DM patients were divided into two groups in a 1∶1 ratio, with 56 cases in each group. The control group was treated with metformin, and the observation group was treated with dapagliflozin combined with metformin. The blood glucose levels［fasting blood glucose(FPG), 2 h postprandial blood glucose(2 hPG), glycosylated hemoglobin A1c(HbA1c)］, homeostasis model assessment-insulin resistance(HOMA-IR), waist circumference, body mass index(BMI), blood lipid indexes［high density lipoprotein(HDL-C), triacylglycerol(TG), low density lipoprotein(LDL-C), total cholesterol(TC)］, intestinal microbiota, serum adropin, chemerin, irisin and adverse reactions were compared between the two groups.
Results The FPG, 2 hPG, HbA1c and HOMA-IR of the observation group were lower than those of the control group at 3 months and 6 months after treatment(P＜0.05). The waist circumference and BMI of the observation group were lower than those of the control group at 6 months after treatment(P＜0.05). At 3 and 6 months after treatment, TG was lower in the observation group than in the control group, and HDL-C was higher than that of the control group(P＜0.05). The number of Enterococcus and Enterobacter in the observation group at 6 months after treatment was lower than that of the control group, while the number of Bacteroides and Lactobacillus was higher than that of the control group(P＜0.05). In the observation group, adropin and irisin were higher than those in the control group at 3 and 6 months after treatment, while chemerin was lower than that in the control group(P＜0.05).
Conclusion Dapagliflozin combined with metformin in the treatment of obesity/overweight T2DM can effectively reduce blood glucose levels, improve insulin resistance, blood lipid metabolism and intestinal microecology, relieve obesity/overweight, and have high safety. Decreasing chemerin and increasing adropin and irisin may be a molecular mechanism for the combined anti-T2DM effect of the two.

Key words: diabetes mellitus, type 2, dapagliflozin, metformin

李丽莉, 冯翠娟, 冯克娜. 达格列净联合二甲双胍在肥胖/超重型T2DM中的应用及对肠道微生态、adropin、chemerin、irisin的影响[J]. 河北医科大学学报, 2021, 42(11): 1266-1271.

LI Li-li, FENG Cui-juan, FENG Ke-na. Application of dapagliflozin combined with metformin in obese/overweight T2DM and its effect on intestinal microbiota, adropin, chemerin, and irisin[J]. Journal of Hebei Medical University, 2021, 42(11): 1266-1271.

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达格列净联合二甲双胍在肥胖/超重型T2DM中的应用及对肠道微生态、adropin、chemerin、irisin的影响

Application of dapagliflozin combined with metformin in obese/overweight T2DM and its effect on intestinal microbiota, adropin, chemerin, and irisin

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