替米沙坦联合卡格列净治疗2型糖尿病伴中心型肥胖患者的疗效分析

doi:10.3760/cma.j.cn441417-20241012-06024

摘要/Abstract

摘要：

目的　探讨替米沙坦联合卡格列净对2型糖尿病伴中心型肥胖患者的临床疗效。方法　采用前瞻性研究，选取2022年1月至2024年1月西安大兴医院接收的88例2型糖尿病伴中心型肥胖患者作为研究对象。通过随机数字表法将患者分为两组，各44例。参照组：男24例，女20例，年龄41～73（54.83±9.97）岁，2型糖尿病病程4～10（6.49±1.31）年；在基础治疗的同时进行卡格列净治疗（每次剂量为100 mg，每日口服1次）。联合组：男26例，女18例，年龄42～72（55.18±10.16）岁，2型糖尿病病程4～9（6.36±1.27）年；在参照组基础上联合替米沙坦治疗（每次剂量为80 mg，每日口服1次）。两组均治疗6个月。比较两组患者治疗前后的肥胖指标［体重指数（BMI）、腰围、腰臀比、内脏脂肪面积（VFA）］、血糖指标［糖化血红蛋白（HbA1c）、空腹血糖（FBG）、餐后2 h血糖（2 hPBG）］、胰岛功能［胰岛素抵抗指数（HOMA-IR）、胰岛β细胞功能指数（HOMA-β）、空腹胰岛素（FINS）］、心血管指标［血清内皮素-1（ET-1）、血管内皮生长因子（VEGF）、血管内皮依赖性舒张功能（FMD）］，以及不良反应发生情况。统计学方法采用t检验、χ²检验。结果　治疗后，联合组患者BMI、腰围、腰臀比、VFA、HbA1c、FBG、2 hPBG、HOMA-IR均低于参照组，FMD高于参照组，差异均有统计学意义（t=7.139、4.869、2.909、2.471、2.743、24.288、3.696、26.441、7.508，均P0.05）；联合组患者FMD水平高于参照组［（10.93±1.88）%比（8.27±1.41）%］，ET-1、VEGF水平均低于参照组［（63.20±7.72）ng/L比（69.17±8.88）ng/L、（8.14±1.29）ng/L比（9.46±1.57）ng/L］，差异均有统计学意义（t=7.508、3.366、4.309，均P0.05）。两组不良反应发生率比较，差异无统计学意义（χ²=1.397，P0.05）。结论　替米沙坦联合卡格列净能改善2型糖尿病伴中心型肥胖患者血糖和体重指标，调整血脂水平，治疗安全，适合临床推广应用。

关键词:

2型糖尿病, 中心型肥胖, 替米沙坦, 卡格列净, 血糖

Abstract:

Objective　To explore the clinical efficacy of telmisartan combined with cagreliflozin for patients with type 2 diabetes mellitus (T2DM) and central obesity. Methods　This was a prospective study. Eighty-eight patients with T2DM and central obesity treated at Xi'an Daxing Hospital between January 2022 and January 2024 were selected as the study objects, and were divided into a reference group and a combination group by the random number table method, with 44 cases in each group. There were 24 males and 20 females in the reference group; they were 41-73 (54.83±9.97) years old; their T2DM course was 4-10 (6.49±1.31) years. There were 26 males and 18 females in the combination group; they were 42-72 (55.18±10.16) years old; their T2DM course was 4-9 (6.36±1.27) years. The reference group received basic treatment and orally took 100 mg of cagreliflozin once per day; in addition, the combination group orally took 80 mg of telmisartan once per day; both groups were treated for 6 months. The obesity-related indicators [body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and visceral fat area (VFA)], glycemic indicators [glycated hemoglobin (HbA1c), fasting blood glucose (FBG), and 2-hour postprandial blood glucose (2 hPBG)], pancreatic islet function [homeostasis model assessment for insulin resistance (HOMA-IR), homeostasis model assessment for beta-cell function (HOMA-β), and fasting insulin (FINS)], and cardiovascular indicators [endothelin-1 (ET-1), vascular endothelial growth factor (VEGF), and flow-mediated dilation (FMD)] before and after the treatment and incidence rates of adverse reactions were compared between the two groups. The statistical analysis was performed using the t and χ² tests. Results　After the treatment, the BMI, WC, WHR, VFA, HbA1c, FBG, 2 hPBG, and HOMA-IR in the combination group were lower than those in the reference group , while the FMD was higher, with statistical differences (t=7.139, 4.869, 2.909, 2.471, 2.743, 24.288, 3.696,26.441, and 7.508; all P0.05); the FMD in the combination group was higher than that in the reference group [(10.93±1.88)% vs. (8.27±1.41)%], while the levels of ET-1 and VEGF were lower [(63.20±7.72) ng/L vs. (69.17±8.88) ng/L and (8.14±1.29) ng/L vs. (9.46±1.57) ng/L], with statistical differences (t=7.508, 3.366, and 4.309; all P0.05). There was no statistical difference in the incidence rate of adverse reactions between the two groups (χ²=1.397; P0.05). Conclusion　Telmisartan combined with cagreliflozin for patients with T2DM and central obesity can improve their blood glucose and body weight indicators and regulate blood lipids, and is safe.

Key words:

Type 2 diabetes mellitus, Central obesity, Telmisartan, Cagreliflozin, Blood glucose

王梦琳屈文艳王移.

替米沙坦联合卡格列净治疗2型糖尿病伴中心型肥胖患者的疗效分析 [J]. 国际医药卫生导报, 2025, 31(6): 1001-1005.

Wang Menglin, Qu Wenyan, Wang Yi.

Telmisartan combined with cagreliflozin in treatment of patients with type 2 diabetes and central obesity [J]. International Medicine and Health Guidance News, 2025, 31(6): 1001-1005.

参考文献

[1] 李传松,刘佳静,刘衍凤. 甘精胰岛素联合司美格鲁肽治疗血糖控制不佳的2型糖尿病合并高血压患者的效果[J]. 国际医药卫生导报,2024,30(11):1807-1811. DOI:10.3760/cma.j.issn.1007-1245.2024.11.010.
[2] 李战,郑路,李燕,等. 脂源性外泌体微小RNA在肥胖进展为2型糖尿病中的研究进展[J]. 中华糖尿病杂志,2024,16(5):590-594. DOI:10.3760/cma.j.cn115791-20230922- 00179.
[3] Saatmann N, Zaharia OP, Strassburger K, et al. Physical fitness and cardiovascular risk factors in novel diabetes subgroups[J]. J Clin Endocrinol Metab, 2022,107(4):1127-1139. DOI: 10.1210/clinem/dgab810.
[4] Magkos F, Lee MH, Lim M, et al. Dynamic assessment of insulin secretion and insulin resistance in Asians with prediabetes[J]. Metabolism, 2022,128:154957.DOI: 10.1016/j.metabol.2021.154957.
[5] 胡威威,李晓荣,田春辉,等. 替米沙坦联合羟苯磺酸钙治疗非杓型高血压合并2型糖尿病疗效的研究[J]. 中国糖尿病杂志,2024,32(5):331-335. DOI:10.3969/j.issn.1006- 6187. 2024.05.003.
[6] 邹俊杰,郭嘉惠,殷汉,等. 卡格列净联合依那普利治疗糖尿病肾病患者的临床研究[J]. 中国临床药理学杂志,2024,40(9):1248-1251. DOI:10.13699/j.cnki.1001-6821. 2024.09.002.
[7] 中华医学会,中华医学会临床药学分会,中华医学会杂志社,等. 肥胖症基层合理用药指南[J]. 中华全科医师杂志,2021,20(5):530-532. DOI:10.3760/cma.j.cn114798- 20210318-00256.
[8] Ottosson F, Smith E, Ericson U,et al. Metabolome-defined obesity and the risk of future type 2 diabetes and mortality[J]. Diabetes Care, 2022,45(5):1260-1267. DOI: 10.2337/dc21-2402.
[9] 杨平,毛晓明. 利拉鲁肽与甘精胰岛素对2型糖尿病患者血糖波动及血脂水平的影响[J]. 中国现代医学杂志,2024,34(10):26-31. DOI:10.3969/j.issn.1005-8982. 2024.10.005.
[10] Bauvin P, Delacôte C, Wandji LCN,et al. Early prediction of the impact of public health policies on obesity and lifetime risk of type 2 diabetes: a modelling approach[J]. PLoS One, 2024 ,19(3):e0301463.DOI: 10.1371/journal.pone.0301463.
[11] 毛智毅,王筱燕,陈晓颖,等. 度拉糖肽联合二甲双胍对肥胖型2型糖尿病患者机体代谢、体脂成分及血清脂肪因子的影响[J]. 药学实践与服务,2024,42(7):305-309. DOI:10.12206/j.issn.2097-2024.202305032.
[12] Luan D, Dadpey B, Zaid J,et al. Adipocyte-secreted IL-6 sensitizes macrophages to IL-4 signaling[J]. Diabetes, 2023,72(3):367-374. DOI: 10.2337/db22-0444.
[13] 邓淑坤,袁鹏,周群燕,等. 基于心肺运动试验的精准有氧运动处方对中心型肥胖患者体成分及代谢指标的影响[J]. 中国康复医学杂志,2023,38(2):199-206. DOI:10.3969/j.issn.1001-1242.2023.02.010.
[14] Abd-Eltawab Tammam A, Rizg WY, Fakhry Boushra A, et al. Telmisartan versus metformin in downregulating myostatin gene expression and enhancing insulin sensitivity in the skeletal muscles of type 2 diabetic rat model[J]. Front Pharmacol, 2023,14:1228525.DOI: 10.3389/fphar.2023.
[15] Tanaka A, Imai T, Shimabukuro M,et al. Association between serum insulin levels and heart failure-related parameters in patients with type 2 diabetes and heart failure treated with canagliflozin: a post-hoc analysis of the randomized CANDLE trial[J]. Cardiovasc Diabetol, 2022 ,21(1):151.DOI: 10.1186/s12933-022-01589-3.
[16] Leisman DE, Privratsky JR, Lehman JR,et al. Angiotensin II enhances bacterial clearance via myeloid signaling in a murine sepsis model[J]. Proc Natl Acad Sci USA,2022,119(34):e2211370119. DOI: 10.1073/pnas.2211370119.
[17] Paixão de Gois B, Figueiredo N, Soares Lopes KL,et al. The impact of the obesity onset on the inflammatory and glycemic profile of women with severe obesity[J]. Surg Obes Relat Dis,2024 ,20(10):976-983. DOI: 10.1016/j.soard.2024.04.015.
[18] 闫雨蒙,张颖,马强,等. 奇数链脂肪酸抑制脂多糖诱导的Caco-2细胞炎症反应研究[J]. 中国油脂,2024,49(6):82-90,111. DOI:10.19902/j.cnki.zgyz.1003-7969.230317.
[19] Dong Y, Wang P, Jiao J, et al. Antihypertensive therapy by ACEI/ARB is associated with intestinal flora alterations and metabolomic profiles in hypertensive patients[J]. Front Cell Dev Biol, 2022,10:861829.DOI: 10.3389/fcell.2022.861829.
[20] 祖晓麟,屈超,叶明,等. 卡格列净对老年2型糖尿病合并射血分数保留型心力衰竭患者胰岛素抵抗和心脏舒张功能的影响及心血管结局[J]. 中国医药,2023,18(6):810-814. DOI:10.3760/j.issn.1673-4777.2023.06.003.
[21] Wu J, Sun Z, Yang S,et al. Kidney single-cell transcriptome profile reveals distinct response of proximal tubule cells to SGLT2i and ARB treatment in diabetic mice[J]. Mol Ther,2022,30(4):1741-1753. DOI: 10.1016/j.ymthe. 2021.10.013.
[22] 刘涛,陈晓琴,郭瑞旺,等. 替米沙坦通过直接抑制Kv2.1通道促进离体大鼠的胰岛素分泌[J]. 中国药理学通报,2024,40(5):893-898. DOI:10.12360/CPB202311061.
[23] 王晶,刘易婷,刘哲. 替米沙坦联合瑞舒伐他汀治疗糖尿病合并冠心病对患者外周胰岛素抵抗、糖化血红蛋白、脂蛋白和心肌缺血的影响[J]. 陕西医学杂志,2022,51(5):595-598. DOI:10.3969/j.issn.1000-7377.2022.05.019.
[24] Fu EL, Wexler DJ, Cromer SJ, et al. SGLT-2 inhibitors, GLP-1 receptor agonists, and DPP-4 inhibitors and risk of hyperkalemia among people with type 2 diabetes in clinical practice: population based cohort study[J]. BMJ, 2024,385:e078483.DOI: 10.1136/bmj-2023-078483.
[25] Huber G, Ogrodnik M, Wenzel J,et al. Telmisartan prevents high-fat diet-induced neurovascular impairments and reduces anxiety-like behavior[J]. J Cereb Blood Flow Metab,2021 ,41(9):2356-2369.DOI: 10.1177/0271678X211003497.