维格列汀联合二甲双胍治疗对2型糖尿病合并心脑血管疾病 IMT、血清 APN 及 Hcy 水平的影响

摘要

ABSTRACT:Objective To observe the effects of vildagliptin combined with metformin on carot-id intima-media thickness (IMT)and serum adiponectin (APN)and homocysteine (Hcy)levels in type 2 diabetes mellitus (T2DM)patients with cardio-cerebral vascular disease (CCVD),and to investigate the risk factors for CCVD in patient with T2DM.Methods One hundred and fifty newly diagnosed T2DM patients with CCVD were randomly treated with vildagliptin (group A, n=50),metformin (group B,n=50)or their combination (group C,n=50).The control of blood glucose and improvement in IMT and serum APN and Hcy levels were assessed after treatment for 3 months.Results The IMT and Hcy levels decreased but APN levels increased after treat-ment for 3 months in both group A and group C (P <0.05).Compared with group A or B,the IMT and levels of Hcy and APN were significantly improved in group C (P <0.05).The IMT was positively correlated with homeostasis model assessment of insulin resistance (HOMA-IR) (r=0.356,P = 0.013),low density lipoprotein (LDL)(r = 0.363,P = 0.009)and Hcy (r =0.756,P =0.022),but negatively correlated with high density lipoprotein (HDL)(r=-0.461, P =0.001)and APN (r=-0.482,P =0.000).Conclusion The increase in HOMA-IR,LDL and Hcy and decrease in HDL and APN are risk factors for IMT thickening in T2DM patients.The combined treatment with vildagliptin and metformin can effectively reduce IMT and Hcy levels and elevate APN contents in T2DM patients with CCVD.%目的：观察维格列汀联合二甲双胍治疗对2型糖尿病合并心脑血管疾病颈动脉内膜中层厚度（carotid inti-ma-media thickness，IMT）、血清脂联素（adiponectin，APN）和同型半胱氨酸（homocysteine，Hcy）水平的影响，探讨2型糖尿病并发心脑血管疾病的危险因素。方法将150例初诊2型糖尿病合并心脑血管疾病患者随机分为3组：A 组50例采用维格列汀治疗，B 组50例采用二甲双胍治疗，C 组50例采用维格列汀联合二甲双胍治疗，治疗3个月后，比较3组治疗前后血糖控制情况及 IMT、APN 和 Hcy 水平改善情况。结果治疗后 A、C 组 IMT、Hcy 均较治疗前明显降低，APN 较治疗前明显增加，且 C 组改善程度较 A、B 组更为显著（P ＜0．05）。相关分析结果显示，IMT 与 HOMA-IR（r＝0．356，P ＝0．013）、LDL（r＝0．363，P ＝0．009）、Hcy（r＝0．756，P ＝0．022）呈正相关，与HDL（r＝－0．461 P ＝0．001）、APN（r＝－0．482，P ＝0．000）呈负相关。结论 HOMA-IR、LDL、Hcy 升高，HDL、APN 降低是2型糖尿病患者 IMT 增厚的危险因素。维格列汀联合二甲双胍治疗可有效降低其 IMT 值及 Hcy 水平，增加 APN 含量。