西格列汀对2型糖尿病心血管并发症相关危险因素及标志物的影响

摘要

目的：观察西格列汀对2型糖尿病患者血糖及心血管并发症相关危险因素及标志物的影响。方法选择2013年1月—2014年6月石家庄市第一医院内分泌科新近诊断且近3个月使用二甲双胍血糖控制不佳的2型糖尿病60例作为研究对象，随机将其分为西格列汀组和阿卡波糖组两组各30例，两组分别在糖尿病常规治疗基础上加用西格列汀每日100 mg或阿卡波糖每日150 mg，观察并比较两组治疗前及治疗24周后体重指数（BMI）、血糖指标、血压、颈动脉内膜中层厚度（ CIMT）及心血管疾病危险因素标志物水平，并观察两组治疗期间不良反应发生情况。结果治疗24周后，两组BMI、空腹血糖、餐后2 h血糖及糖化血红蛋白水平均较治疗前下降，其中西格列汀组BMI较阿卡波糖组下降更明显，差异均有统计学意义（ P＜0.05）。治疗24周后CIMT，西格列汀组较治疗前减小，西格列汀组较阿卡波糖组小，差异有统计学意义（ P＜0.05）。治疗24周后血浆同型半胱氨酸、C反应蛋白、甘露糖结合凝集素、I型血浆纤溶酶原活化抑制物及基质金属蛋白酶-9水平，西格列汀组较治疗前明显下降，西格列汀组较阿卡波糖组低，差异亦均有统计学意义（ P＜0.05）。结论西格列汀降糖效果与阿卡波糖相当，但西格列汀还可降低体重和心血管疾病危险因素及标志物水平，对心血管可能具有保护作用。%Objective To investigate the effect of Sitagliptin on glucose and risk factors , relevant risk factors of car-diovascular complications in type 2 diabetes mellitus .Methods 60 patients selected in the study were first diagnosed with type 2 diabetes in the endocrinology department of the First Hospital of Shjiazhuang during January 2013 and June 2014 .They had poor glucose control after being treated with Metformin in the latest 3 months.The patients were randomly divided into Sitagliptin group (30 cases) and Acarbose group (30 cases).The two groups were respectively given a daily dose of 100 mil-ligram of Sitagliptin and a daily dose of 150 milligram of Acarbose in addition to routine treatment for 24 weeks.The body mass index (BMI), glucose level, blood pressure, carotid intimae media thickness (CIMT) and the markers of cardiovascular risk factor of the two groups pretherapy and 24 weeks after treatment were observed and compared .The adverse reaction of two groups during therapy was also observed .Results Compared with that of pretherapy , the levels of BMI , level of fasting plas-ma glucose, 2-hour postprandial blood glucose and glycosylated hemoglobin were decreased after 24 weeks of treatment in both groups.After 24 weeks of treatment , the Sitagliptin group had a greater decrease in BMI , compared with the Acarbose group ( P<0.05 ) .Compared with that of pretherapy , the CIMT was decreased in Sitagliptin group after 24 weeks of treatment .Af-ter 24 weeks of treatment , compared with Acarbose group , the CIMT in Sitagliptin group was obviously reduced ( P<0.05 ) . Compared with that of pretherapy , the levels of homocysteine , C-reactive protein , mannose binding lectin , plasminogen activa-tor inhibitor-1, mat-rix metalloproteinase-9 declined significantly in the Sitagliptin group after 24 weeks of treatment .After 24 weeks of treatment , compared with those of Acarbose group , the markers of Sitagliplin group were lower ( P<0.05 ) .Conclu-sion Sitagliptin has similar effect in reducing blood glucose level as Acarbose , but Sitagliptin can reduce body weight effec-tively and has some protective effect on cardiovascular complications through inhibition of theses markers .