目的 探究二甲双胍联合维格列汀治疗肥胖型2型糖尿病的临床疗效。方法 选取2010年3月—2013年2月来重庆市忠县人民医院就诊的肥胖型2型糖尿病患者106例，依据分层随机分组法将患者分为治疗组（53例）和对照组（53例）。对照组给予常规疗法，随餐同服二甲双胍0.5 g/次，2次/d，后依据病情以0.5 g/2周逐渐增量，最大剂量不超过2.5 g/d，同时早餐前口服吡格列酮，起始剂量15 mg/d，最大剂量不超过45 mg/d；治疗组口服二甲双胍，用法用量同对照组，同时随餐口服维格列汀50 mg/次，2次/d。两组患者均治疗6个月。比较两组患者治疗前后体质量指数（BMI）、糖化血红蛋白（HbA1c）、糖化白蛋白（GSP）、空腹血糖（FBG）、餐后2小时血糖（2hPBG）、胰高血糖素样肽-1（GLP-1）、三酰甘油（TG）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、治疗总有效率，同时观察两组患者可能出现的不良反应。结果 治疗后两组患者的BMI、HbA1c、GSP、FBG、2hPBG、TG、TC及LDL-C均较治疗前有所下降，差异均有统计学意义（P<0.05）；治疗后，治疗组患者的BMI、HbA1c、GSP、FBG、2hPBG、TG、TC及LDL-C均较对照组下降更加明显，差异有统计学意义（P<0.05）。治疗后治疗组患者的GLP-1和HDL-C均明显高于对照组，两组比较差异有统计学意义（P<0.05）。治疗后，治疗组和对照组的总有效率分别为98.11%、86.79%，两组比较差异有统计学意义（P<0.05）。结论 二甲双胍联合维格列汀治疗肥胖型2型糖尿病可有效控制患者的血糖和体质量，且不增加低血糖风险，同时也可达到降低血脂的作用，值得临床推广应用。

Objective To explore the efficacy of metformin combined with vildagliptin in treatment of type 2 diabetes with obesity. Methods Obese patients (106 cases) with type 2 diabetes who came to Zhongxian People's Hospital of Chongqing City for treatment from March 2010 to February 2013 were divided into treatment and control groups according to the stratified randomization method (n = 53). The patients in the control group were given metformin (0.5 g/time, twice daily) with meals at the basis of conventional therapy, in the 0.5 g/2 weeks gradual increments based on the condition of disease and the maximum dosage does not exceed 2.5 g/d. At the same time, they were po administered with pioglitazone before breakfast, at the starting dosage of 15 mg/d and the maximum dosage should not exceed 45 mg daily. The patients in the treatment group were given metformin, with the same usage and dosage as the control group. The patients in the treatment group were given vildagliptin with meals, 50 mg/time, twice daily. The patients in the two groups were treated for 6 months. The indexes of two groups such as body mass index (BMI), glycated hemoglobin (HbA1c), glycated albumin (GSP), fasting blood glucose (FBG), 2-hour postprandial glucose (2hPBG ), glucagon-like peptide-1 (GLP-1), triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), and total effective rate were compared. Adverse reactions of two groups were observed. Results After treatment, BMI, HbA1c, GSP, FBG, 2hPBG, TG, TC, and LDL-C of the two groups decreased, and the difference had statistical significance (P < 0.05). After treatment, BMI, HbA1c, GSP, FBG, 2hPBG, TG, TC, and LDL-C in the treatment group dropped off more sharply than those in the control group, and the difference between the two groups was statistically significant (P < 0.05). After the treatment, the total effective rates in the treatment and control groups were 98.11% and 86.79%. And there were significant differences between the two groups (P < 0.05). Conclusion Metformin combined with vildagliptin in treatment of type 2 diabetes with obesity can effectively control the blood sugar and body quality of patients, and does not increase the risk of hypoglycemia, at the same time it also can reduce blood fat, which is worthy of clinical popularization and application.

国家自然科学基金资助项目（30971129）