目的 探究司美格鲁肽联合恩格列净治疗肥胖2型糖尿病的临床效果。方法 选取2022年9月—2023年12月在西安交通大学第二附属医院治疗的肥胖2型糖尿病患者199例，根据治疗方案差异分成对照组（99例）和治疗组（100例）。对照组患者口服恩格列净片，10 mg/次，1次/d。治疗组患者在对照组基础上皮下注射司美格鲁肽注射液，1次/周，前4周0.25 mg/周，5～8周0.5 mg/周，9周开始剂量1 mg/周。两组患者均进行12周治疗。观察两组患者临床疗效，比较治疗前后两组患者症状负担评估量表（DSC-R）和糖尿病生存质量特异性量表（DSQL）评分，血糖指标糖化血红蛋白（HbA1c）、空腹血糖（FBG）和餐后2 h血糖（2 h PG）水平，及血脂指标总胆固醇（TC）、三酰甘油（TG）和高密度脂蛋白胆固醇（HDL-C）水平。结果 治疗后，对照组和治疗组的总有效率分别为85.86%和97.00%，两组比较差异具有统计学意义（P＜0.05）。治疗后，治疗组患者DSC-R评分和DSQL评分明显下降（P＜0.05），且治疗组评分明显优于对照组（P＜0.05）。治疗后，两组患者血糖指标HbA1c、FBG、2 h PG水平均较治疗前显著下降（P＜0.05），且治疗组血糖指标明显优于对照组（P＜0.05）。治疗后，两组血脂指标TC、TG水平较治疗前显著下降，而HDL-C显著升高（P＜0.05），且治疗组患者血脂指标显著优于对照组（P＜0.05）。结论 司美格鲁肽联合恩格列净治疗肥胖2型糖尿病治疗效果显著，不仅能够显著改善患者症状负担水平和生存质量，同时还能够促进糖脂代谢指标的恢复。

Objective To explore the therapeutic effect of semaglutide combined with empagliflozin in treatment of obese type 2 diabetes.Methods Patients (199 cases) with obese type 2 diabetes in the Second Affiliated Hospital of Xi’an Jiaotong University from September 2022 to December 2023 were divided into control (99 cases) and treatment (100 cases) group based on different treatments. Patients in the control group were po administered with Empagliflozin Tablets, 10 mg/time, once daily. Patients in the treatment group were sub-cutaneous administered with Semaglutide Injection, 0.25 mg/week for the first 4 weeks, 0.5 mg/week for 5 — 8 weeks, and 1 mg/week from week 9, once weekly. Patients in two groups were treated for 12 weeks. After treatment, the clinical evaluations were evaluated, the scores of DSC-R and DSQL, the levels of blood glucose indexes HbA1c, FBG and 2 h PG, and the levels of blood lipid indexes TC, TG and HDL-C in two groups before and after treatment were compared. Results After treatment, the total clinical effective rates in the control group and the treatment group were 85.86% and 97.00%, respectively, and the difference between the two groups was statistically significant (P < 0.05). After treatment, the DSC-R and DSQL scores in the treatment group were significantly decreased (P < 0.05), and the score of the treatment group was significantly better than that of the control group (P < 0.05). After treatment, the blood glucose indicators HbA1c, FBG, and 2 h PG levels in two groups were significantly decreased compared with those before treatment (P < 0.05), and the blood glucose indicators in the treatment group were significantly better than those in the control group (P < 0.05). After treatment, the levels of blood lipids TC and TG in two groups were significantly decreased compared with those before treatment, while HDL-C was significantly increased (P < 0.05), and the blood lipids in the treatment group were significantly better than those in the control group (P < 0.05). Conclusion Smeglutide combined with empagliflozin has a significant therapeutic effect in the treatment of obese type 2 diabetes, which can not only significantly improve the burden of symptoms and quality of life of patients, but also promote the recovery of glucose and lipid metabolism indicators.

R977

陕西省重点研发计划项目（2022SF-140）