不同减重方式对2型糖尿病肥胖患者体脂分布、血糖波动及SFRP5、APN、LP的调节作用.pdf

联勤军事医学2 0 2 3年6 月2 8 日第37 卷第6 期Mil Med Jnt Log,Vol.37,No.6,June 28,2023477不同减重方式对2 型糖尿病肥胖患者体脂分布、血糖波动及SFRP5、A PN、LP的调节作用黎俊森，刘丹，黎培爱，崔静【摘要】目的双观察不同减重方式对2 型糖尿病肥胖患者内脏脂肪含量、血糖控制及分泌型卷曲相关蛋白5(secre-torycurlrelatedprotein.5，SFRP5）、脂联素（adiponectin，A PN）、瘦素（leptin，LP)的调节作用，以期寻找一种更适合于糖尿病合并肥胖人群的减重、降糖模式。方法选取2 0 18-0 6/2 0 2 0-12 月作者医院2 型糖尿病肥胖患者195例，以随机数字表法分为试验A组、试验B组、试验C组、试验D组、对照组，每组各39例。试验A组给予限制热量平衡饮食，试验B组给予正常热量饮食联合口服二甲双胍、试验C组给予正常热量饮食联合口服奥利司他、试验D组给予正常热量饮食联合利拉鲁肽，对照组给予正常热量饮食，均治疗3个月。比较5组治疗前、治疗3个月后体质量、体质量指数（bodymass index,BMI)、腰围、内脏脂肪含量、糖化血红蛋白（haemoglobinArc,HbArc)、空腹血糖（fastingblood glucoseFPG)、餐后2 h血糖（postprandial 2-hourblood glucose,2hPG)、高密度脂蛋白胆固醇（high-density lipoprotein cholester-ol,HDL-C)、低密度脂蛋白胆固醇（lowdensitylipoprotein cholesterolLDL-C)、总胆固醇（totalcholesterol,TC)、甘油三酯(triglycerides，T G)、稳态模型胰岛素抵抗指数(homeostatic model assessment for insulin resistance,HOMA-IR)、稳态模型胰岛细胞功能指数（homeostaticmodel assessment of-cell function，H O M A-）、SFRP5、A PN、LP水平。结果治疗3个月后,患者体质量、BMI、腰围、内脏脂肪含量组间比较,试验C组 试验D组 试验B组 试验A组 对照组（P0.05);H b A r c、FPG、2 h PG 水平组间比较，试验B组和试验D组 试验C组 试验A组 对照组（P0.05)；LD L-C、T C、T G 水平组间比较，试验C组 试验D组 试验B组 试验A组 对照组（P 试验D组 试验B组 试验A组 对照组（P0.05）H O M A-I R、H O M A-水平组间比较，试验B组和试验D组 试验C组 试验A组 对照组（P 试验C组 试验B组 试验A组 对照组（P 试验B组 试验A组 对照组(P0.05),LP水平组间比较,试验C组 试验D组 试验B组 试验A组 对照组(P0.05)。结论2 型糖尿病肥胖患者采用二甲双胍、利拉鲁肽治疗降糖、调节胰岛素敏感性作用显著，采用奥利司他治疗减重、降脂效果显著，还可调节SFRP5、A PN、LP表达水平，减轻LP抵抗状态，加速脂肪分解及糖代谢。【关键词】减重方式；肥胖症；2 型糖尿病；内脏脂肪含量；血糖控制；脂联素；分泌型卷曲相关蛋白5；瘦素【中图分类号】R 587.1【文献标识码】Adoi:10.13730/j.issn.2097-2148.2023.06.005Effects of Different Weight Loss Methods on Body Fat Distribution,Blood Glucose Fluctuation and Regulation of SFRP5,NandDmOoDMellitlsNandpPatientsWithDiabetes MellitusI Junsen,LIU Dan,LI Peiai,CUI Jing.Department of Endocrinology,Sanya Central Hospital(Hainan Provincehird Peoples Hospital),Sanya Hainan 572000,China【A b s t r a c t】Objective To observe the regulatory effects of different weight loss methods on visceral fat content,blood sugar control and secretory curl related protein 5(SFRP5),adiponectin(APN)and leptin(LP)in obese patientswith diabetes,so as to find a more suitable lose weight and hypoglycemic mode for obese patients with diabetic mellitus.MethodsA total of 195 obese patients with type 2 diabetes mellitus in authors hospital from June 2018 to December2020 were divided into study A group,study B group,study C group,study D group and control group by random num-ber table,with 39 cases in each.Study A group was given a balanced calorie diet,group B was given a normal calorie dietcombined oral metformin,group C was given a normal calorie diet combined oral orlistat,group D was given a normal cal-orie diet combined liraglutide,and the control group was given the normal calorie diet,with treatment for 3 months ineach.The levels of body mass,body mass index(BMI),waist circumference,visceral fat content,haemoglobin Arc(HbA,c),fasting blood glucose(FPG),postprandial 2-hour blood glucose(2hPG),high-density lipoprotein cholesterol【基金项目】海南省卫生健康行业科研项目（2 0 A200372）【作者单位】572000海南三亚，三亚市中心医院（海南省第三人民医院）内分泌科（黎俊森、刘丹、黎培爱、崔静）(HDL-C),low density lipoprotein cholesterol(LDL-C),total cholesterol(TC),triglycerides(TG),homeostaticmodel assessment for insulin resistance(HOMA-IR),ho-meostatic model assessment of-cell function(HOMA-),SFRP5,APN and LP in the 5 groups were comparedMilMed JntLo6,June28,2023联勤军事医学2 0 2 3年6 月2 8 日第37 卷第6 期478before treatments and 3 months after treatments.Results After 3 months of treatments,O Body mass,BMI,waistcircumference and visceral fat content of patients among groups were compared,study C group study D group studyB groupstudy A groupcontrol group(P0.05);T h e l e v e l s o f H b A r c,FPG a n d 2 h PG a mo n g g r o u p s w e r e c o m-pared,study B group and study D groupstudy C group study A group control group(P0.05);T h e l e v e l s o fLDL-C,TC and TG among groups were compared,study C groupstudy D groupstudy B group study A group control group(P study D groupstudy Bgroupstudy A groupcontrol group(P0.05);The levels of HOMA-IR and HOMA-among groups were com-pared,study B group and study D groupstudy C groupstudy A group control group(Pstudy C groupstudy B groupstudy A groupcontrolgroup(P study D group study B group study A group control group(P0.05),the levels of LP among groups were compared,study C group study Dgroup study B group study A group control group(P0.05),具有可比性，见表1。本研究经作者医院医学伦理委员会批准2 0 18（科研）第（9)号。表1患者一般资料比较（n=39/组）Table 1Comparison of general data of patients(n=39/group)项目对照组试验A组试验B组试验C组试验D组F/x2值P值性别 n(%)4.2260.376男15(38.46)22(56.41)20(51.28)23(58.97)18(46.15)女24(61.54)17(43.59)19(48.72)16(41.03)21(53.85)年龄（岁，工土s)43.027.8045.02 7.1644.397.4547.18 6.8944.79 6.971.6670.159病程（年，土s)2.80 0.603.02 0.642.78 0.552.95 0.603.05 0.591.6920.153内脏脂肪面积（cm,土s）187.96 26.39179.45 25.26184.59 28.84177.56 26.65183.98 27.150.9430.441全身脂肪百分比（%，工土s）36.085.5434.15 5.0635.065.2133.895.4035.39 4.771.6670.327四肢骨骼肌指数（kg/m，s)8.090.747.920.728.260.627.94 0.648.220.602.1330.0781.2纳入与排除标准1.2.1纳人标准符合中国成人肥胖症防治专家共识6 中肥胖症诊断标准者；符合中国2 型糖尿病防治指南(2