GLP-1类似物对早期2型糖尿病患者血浆胰岛素水平及血压的影响

发布时间：2018-08-12 10:42

【摘要】：目的:收集整理早期2型糖尿病患者应用胰高血糖素样肽-1类似物(Glucagon-like Peptide-1,GLP-1)治疗前后的一般资料及实验室检查指标,分析GLP-1受体激动剂对早期2型糖尿病患者血浆胰岛素水平以及对血压的影响,并且探讨胰高血糖素样肽—1类似物与胰岛素抵抗、高血压和血管紧张素II之间的关系,为临床治疗提供进一步理论支持。方法:依据世界卫生组织糖尿病专家委员会于1999年所提出的诊断标准,选出自2013年6月~2014年10月于天津港口医院、天津医科大学总医院内分泌科就诊的60例早期2型糖尿病患者作为研究对象,详细记录患者一般情况与既往史。分别在GLP-1类似物治疗前及治疗后第8周、第12周,测量患者身高、体重,计算BMI,记录腰围、腹围;检测患者全天不同时段、间隔大于4小时的三次以上血压,计算并记录血压的平均水平;检测空腹血糖、餐后血糖、总胆固醇、甘油三酯、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、糖化血红蛋白、C反应蛋、空腹胰岛素、肾素、血管紧张素II与醛固酮。根据血管紧张素II水平进行分组,血管紧张素II100ng/L为高血管紧张素组(A组),血管紧张素II≤100ng/L为正常血管紧张素组(B组)。比较A组与B组年龄(Age,AGE)、体重(Weight,W)、体重指数(Body mass index,BMI)、血压(Blood pressure,BP)、空腹血糖(Fast plasma glucose,FPG)、餐后血糖(Post plasma glucose,PPG)、糖化血红蛋白(Hemoglobin C,HBA1C)、甘油三酯(Triglyceride,TG)、胆固醇(Total cholesterol,TC)、高密度脂蛋白(High density lipoprotein,HDL)、低密度脂蛋白(Low density lipoprotein,LDL)、C反应蛋白(C reaction protein,CRP)、血管紧张素Ⅱ(Angiotensin II,AngⅡ)、空腹胰岛素(Fast insulin,FINS)、胰岛素抵抗指数(Insulin resistance index,HOMA-IR)与腰围,应用SPSS 18统计软件进行统计学分析,实验数据中计量资料以均数±标准差(x±S)表示。两组间计量资料的比较,首先采取正态分布方法检测样本分布情况,再采用t检验比较两样本均数,用药前后比较采用配对样本t检验,计数资料的比较采用χ2检验。两因素之间的相关分析采用Pearson相关分析。结果:1.A组与B组各项指标比较AGE、W、BMI、BP、FPG、PPG、HBA1C、TG、TC、HDL、LDL、CRP、FINS、HOMA-IR与腰围,差异无统计学意义(P0.05),AngⅡ差异有统计学意义(P0.05)。2.A组应用GLP-1前后各项指标比较W、BMI、BP、FPG、PPG、HBA1C、TG、LDL、CRP、AngⅡ、FINS、HOMA-IR与腰围,差异有统计学意义(P0.05)。3.B组应用GLP-1前后各项指标比较W、BMI、BP、FPG、PPG、HBA1C、TG、LDL、CRP、FINS、HOMA-IR与腰围,差异有统计学意义(P0.05)。4.治疗12周后A组与B组W、BMI、腰围、BP、FPG、PPG、HBA1C、TC、TG、HDL、LDL、CRP、FINS、HOMA-IR治疗结果达标情况均无统计学意义(P0.05)。5.GLP-1治疗后,A组与B组Ang II、HOMA-IR、SBP、与CRP存在Pearson两两正相关。结论:1.早期2型糖尿病患者经GLP-1 0.6-1.8mg/日治疗12周,血糖、糖化血红蛋白较前显著改善,证实GLP-1具有良好的降糖作用;体重、腰围与BMI水平较前显著降低,说明GLP-1可以改善患者的肥胖状态;此外,患者血浆胰岛素水平下降,经计算HOMA-IR降低,说明GLP-1可以改善患者的胰岛素抵抗状态。同时本研究也发现GLP-1使合并高血压的早期2型糖尿病患者血压水平降低,其中以收缩压为著。对于Ang II100 ng/L的早期2型糖尿病患者,经GLP-1治疗后,Ang II水平显著降低,推测患者血压水平下降可能与Ang II下降有关;但Ang II≤100 ng/L的早期2型糖尿病患者,血压也下降,推测可能与RAS系统以外的因素有关。2.通过治疗结果分析,显示患者Ang II与HOMA-IR、SBP、CRP水平呈现Pearson两两正相关,说明患者Ang II与HOMA-IR、CRP是患者SBP变化的重要影响因素。
[Abstract]:Objective: To collect and sort out the general data and laboratory examination indexes of glucagon-like Peptide-1 (GLP-1) before and after treatment in patients with early type 2 diabetes mellitus, analyze the effect of GLP-1 receptor agonists on plasma insulin level and blood pressure, and explore the effect of GLP-1 receptor agonists on blood pressure in patients with early type 2 diabetes mellitus. Methods: According to the diagnostic criteria put forward by the WHO Diabetes Expert Committee in 1999, the patients were selected from June 2013 to October 2014 in Tianjin Port Hospital and Tianjin Medical University General Hospital. Sixty patients with early type 2 diabetes mellitus were enrolled in the Department of secretion, and their general condition and past history were recorded in detail. Mean blood pressure was calculated and recorded; fasting blood glucose, postprandial blood glucose, total cholesterol, triglyceride, low density lipoprotein cholesterol, high density lipoprotein cholesterol, glycosylated hemoglobin, C-reactive eggs, fasting insulin, renin, angiotensin II and aldosterone were measured and grouped according to angiotensin II levels, angiotensin II 100ng/L. Angiotensin II < 100 ng / L was normal angiotensin group (group B). Age (Age, AGE), weight (W), body mass index (BMI), blood pressure (BP), fasting plasma glucose (FPG), postprandial plasma glucose (PPG), glycosylated hemoglobin (He) were compared between group A and group B. Moglobin C, HBA1C, triglyceride (TG), total cholesterol (TC), high density lipoprotein (HDL), low density lipoprotein (LDL), C reactive protein (CRP), angiotensin II (Ang II), fasting insulin (FINS), islet Insulin resistance index (HOMA-IR) and waist circumference were analyzed by SPSS 18 statistical software. The measurement data were expressed as mean (+) standard deviation (x (+) S). The normal distribution method was used to detect the distribution of samples, and t test was used to compare the mean of the two samples before treatment. Results: 1. The indexes of AGE, W, BMI, BP, FPG, PPG, HBA1C, TG, TC, HDL, LDL, CRP, FINS, HOMA-IR and waist circumference were compared between group A and group B, and there was no significant difference (P 0.05). Ang II was statistically significant (P 0.05). The indexes of W, BMI, BP, FPG, PPG, HBA1C, TG, LDL, CRP, Ang II, FINS, HOMA-IR and waist circumference were significantly different before and after GLP-1 treatment (P 0.05). 3. The indexes of W, BMI, BP, FPG, PPG, HBA1C, TG, LDL, CRP, FINS, HOMA-IR and waist circumference in group B before and after GLP-1 treatment were significantly different (P 0.05). After treatment with MI, waist circumference, BP, FPG, PPG, HBA1C, TC, TG, HDL, LDL, CRP, FINS, HOMA-IR, there was no significant difference (P 0.05). GLP-1 has a good hypoglycemic effect, body weight, waist circumference and BMI levels were significantly lower than before, indicating that GLP-1 can improve obesity in patients; in addition, the plasma insulin level decreased, calculated HOMA-IR decreased, indicating that GLP-1 can improve insulin resistance in patients. At the same time, this study also found that GLP-1 can improve insulin resistance in patients with hyperglycemia. For early type 2 diabetes with Ang II 100 ng/L, after GLP-1 treatment, the level of Ang II decreased significantly, which may be related to the decrease of Ang II; but for early type 2 diabetes with Ang II < 100 ng/L, the blood pressure also decreased, presumably. The results showed that Ang II was positively correlated with HOMA-IR, SBP and CRP levels, indicating that Ang II and HOMA-IR, CRP were important influencing factors of SBP changes.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R587.1

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