目的 观察艾塞那肽注射液治疗2型糖尿病合并高血压的临床疗效。方法 选取2008年1月-2015年1月重庆市沙坪坝区人民医院收治的糖尿病合并高血压患者97例。所有患者随机分为对照组(51例)和治疗组(46例)。对照组患者给予常规基础治疗。治疗组患者在对照组治疗基础上sc艾塞那肽注射液,起始剂量5μg/次,2次/d,治疗4周;然后改用剂量10μg/次,2次/d。两组患者均治疗24周。观察两组的血糖、血压临床控制的临床疗效,同时比较两组血糖、血脂、体质量指数(BMI)、糖化血红蛋白(HbA1c)、血压、超敏C反应蛋白(Hs-CRP)、脂联素和肿瘤坏死因子-α(TNF-α)。结果 治疗后,对照组血糖控制总有效率为58.82%,治疗组血糖控制总有效率为80.43%,两组血糖控制总有效率比较差异具有统计学意义(P<0.05)。对照组血压控制总有效率为49.02%,治疗组血压控制总有效率为91.30%,两组血压控制总有效率比较差异具有统计学意义(P<0.05)。治疗后,两组空腹血糖(FPG)、餐后2 h血糖(PPG)、三酰甘油(TG)、HbA1c较治疗前显著下降,同组治疗前后差异具有统计学意义(P<0.05),且治疗组这些指标的改善程度优于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后两组患者总胆固醇(TC)、BMI比较差异具有统计学意义(P<0.05)。治疗后,两组收缩压(SBP)、舒张压(DBP)较治疗前显著下降,同组治疗前后差异具有统计学意义(P<0.05),且治疗组这些观察指标的下降程度优于对照组,两组比较差异具有统计学意义(P<0.05)。对照组Hs-CRP、脂联素和TNF-α治疗前后无明显差异,但在治疗组治疗后较治疗前显著降低(P<0.05),且治疗组这些观察指标的下降程度优于对照组,两组比较差异具有统计学意义(P<0.05)。结论 艾塞那肽注射液治疗2型糖尿病合并高血压具有较好的临床效果,可显著改善HbA1c、血压、BMI、Hs-CRP、脂联素、TNF-α,具有一定的临床推广应用价值。

Objective To observe the clinical effect of Exenatide Injection in treatment of type 2 diabetes with hypertension. Methods Patients (97 cases) with type 2 diabetes with hypertension in The Hospital of Chongqing Shapingba District People's Hospital from January 2008 to January 2015 were randomly divided into control (51 cases) and treatment (46 cases) groups. The patients in the control group were given the conventional treatment. The patients in the treatment group were sc administered with Exenatide Injection, and initial dose was 5 μg/time, twice daily for four weeks. Then dose was adjusted to 10 μg/time, twice daily. The patients in two groups were treated for 24 weeks. After treatment, the clinical efficacies of blood glucose and blood pressure control were evaluated. Blood glucose, blood lipid, body mass index (BMI), glycosylated hemoglobin (HbA1c), blood pressure, high sensitive C reactive protein (Hs-CRP), adiponectin and tumor necrosis factor-α (TNF-α) were compared between two groups. Results After treatment, the clinical efficacies of blood glucose control in the control and treatment groups were 58.82% and 80.43%, respectively, and there were differences between two groups (P < 0.05). While the clinical efficacies of blood pressure control in the control and treatment groups were 49.01% and 91.30%, respectively, and there were differences between two groups (P < 0.05). After treatment, fasting blood glucose (FPG), postprandial 2 h blood glucose (PPG), triglyceride (TG), and HbA1c in two groups were significantly decreased, and the difference was statistically significant in the same group (P < 0.05). After treatment, the observational indexes in the treatment group were significantly higher than those in the control group, with significant difference between two groups (P < 0.05). After treatment, total cholesterol (TC) and BMI in two groups were significantly increased, and the difference was statistically significant between two groups (P < 0.05). After treatment, systolic blood pressure (SBP) and diastolic blood pressure (DBP) in two groups were significantly decreased, and the difference was statistically significant in the same group (P < 0.05). After treatment, the observational indexes in the treatment group were significantly lower than those in the control group, with significant difference between two groups (P < 0.05). There were no difference of Hs-CRP, adiponectin, and TNF-α in the control group before and after treatment, but those index in the treatment group were significantly decreased after treatment (P < 0.05), and the observational indexes in the treatment group were significantly higher than those in the control group, with significant difference between two groups (P < 0.05). Conclusion Exenatide Injection has clinical curative effect in treatment of type 2 diabetes with hypertension, and can improve HbA1c, blood pressure, BMI, Hs-CRP, adiponectin and TNF-α, which has a certain clinical application value.

中华医学会临床医学专项资金资助项目(13020120397,13040630448)