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目的:应用艾塞那肽治疗口服药物血糖控制不佳的2型糖尿病患者,评价其降糖疗效、对体重及全身各部位体质成分的影响。方法:选取2011年2月-2012年6月本收治的15例口服药物血糖控制不佳的2型糖尿病患者,在原有口服降糖药基础上,联用艾塞那肽皮下注射3个月,用药前后分别通过人体成分分析仪测定体重、体重指数、体脂百分数、腰臀脂肪比率及内脏脂肪区域,通过双能X线骨密度仪测定上肢、下肢、躯干及全身脂肪量及脂肪百分比、肌肉及骨矿物盐含量,并进行统计。结果:经过3个月的治疗,患者HbA1c有所下降,与治疗前比较差异有统计学意义(t=3.472,P<0.01);腰围、臀围及腰臀比有所下降,但差异无统计学意义(P>0.05);治疗后体重、体重指数、体脂百分比及内脏脂肪区域均明显下降,与治疗前比较差异均有统计学意义(t体重=4.424,P<0.01;t体重指数=4.337,P<0.01;t体脂百分比=4.426,P<0.01;t内脏脂肪区域=4.025,P<0.01);腰臀脂肪比率有所下降,但差异无统计学意义(P>0.05);治疗后下肢、躯干、全身脂肪量较治疗前均明显下降,差异有统计学意义(t下肢脂肪量=4.008,P<0.01;t躯干脂肪量=2.914,P<0.05;t全身脂肪量=3.474,P<0.01);下肢、躯干、全身脂肪百分比较治疗前明显下降,差异有统计学意义(t下肢脂肪百分比=2.405,P<0.05;t躯干脂肪百分比=2.756,P<0.05;t全身脂肪百分比=2.281,P<0.05);上肢脂肪量及脂肪百分比有所下降,但差异无统计学意义(P>0.05);治疗前后上肢、下肢、躯干、全身肌肉及骨矿物盐含量无明显改变;治疗后体重下降幅度与躯干和全身脂肪量下降幅度高度相关(r=0.860、0.819,P<0.01);治疗后全身脂肪量下降幅度与下肢和躯干脂肪量下降幅度高度相关(r=0.834、0.955,P<0.01)。结论:口服药控制不佳的2型糖尿病加用艾塞那肽治疗,在有效地控制血糖的同时,可减轻体重,减重以脂肪量减少为主,主要减少下肢、躯干脂肪,对肌肉和骨矿物盐含量无影响。
OBJECTIVE: To evaluate the effects of exenatide on type 2 diabetes patients with poor glycemic control of oral drugs on body weight and body composition in different parts of the body. Methods: From February 2011 to June 2012, 15 patients with type 2 diabetes mellitus who did not receive good blood glucose control were enrolled in this study. On the basis of the original oral antidiabetic drugs, subcutaneous injection of exenatide for 3 months, Before and after treatment, body weight, body mass index, body fat percentage, waist-hip fat ratio and visceral fat area were measured by the human body composition analyzer. The upper extremity, lower extremity, trunk and whole body fat mass and fat percentage were measured by dual energy X-ray absorptiometry. And bone mineral salt content, and statistics. Results: After 3 months of treatment, the HbA1c level of patients decreased slightly compared with that before treatment (t = 3.472, P <0.01); while the waist circumference, hip circumference and waist-hip ratio decreased but the difference was not statistically significant (T> = 4.424, P <0.01; t = body weight index = body weight index = body weight index, body fat percentage and visceral fat area were significantly decreased after treatment, 4.337, P <0.01; t body fat percentage = 4.426, P <0.01; t visceral fat area = 4.025, P <0.01); but there was no significant difference The amount of fat in the lower extremity, body trunk and whole body decreased significantly compared with that before treatment (t = 4.008, P <0.01; t = body fat mass = 2.914, P <0.05; P <0.01). The percentages of lower limbs, body trunk and whole body fat decreased significantly compared with those before treatment (t lower fat percentage = 2.405, P <0.05; t trunk fat percentage = 2.756, P <0.05; = 2.281, P <0.05). The fat mass and fat percentage of upper limbs decreased, but the difference was not statistically significant (P> 0.05). Before and after treatment, upper limbs, lower limbs, , There was no significant change in the content of total muscle and bone mineral. After treatment, the decrease of body weight was closely related to the reduction of body fat and body mass (r = 0.860,0.819, P <0.01) The decrease of fat mass was highly correlated (r = 0.834,0.955, P <0.01). Conclusion: Type 2 diabetes mellitus with poor oral control plus exenatide treatment can effectively reduce body weight while controlling blood glucose. Weight loss is mainly based on the reduction of fat mass, mainly reducing the fat of lower extremities and torso, No effect on bone mineral salt content.