目的 探讨恩格列净联合利格列汀治疗2型糖尿病的临床疗效。方法 选取2018年6月-2019年8月武汉亚心总医院收治的120例2型糖尿病患者作为研究对象。将患者随机分为对照组和观察组，每组各60例。对照组患者口服利格列汀片，5 mg/次，1次/d；观察组在对照组的基础上口服恩格列净片，10 mg/次，1次/d。所有患者均经24周连续服药治疗。观察两组的临床疗效，比较两组患者治疗前后的体质量指数（BMI）、空腹血糖（FBG）、餐后2 h血糖（2 h PG）、糖化血红蛋白（HbA1c）、空腹胰岛素（FINS）、餐后2 h胰岛素（2 h INS）、肿瘤坏死因子（TNF-α）、白细胞介素-4（IL-4）、白细胞介素-6（IL-6）、谷胱甘肽过氧化物酶（GSH-px）、超氧化物歧化酶（SOD）、丙二醛（MDA）水平。结果 治疗后，对照组和观察组总有效率分别为86.67%和95.00%，两组比较差异具有统计学意义（P<0.05）。治疗后，观察组患者BMI值比治疗前显著降低，同组治疗前后比较差异具有统计学意义（P<0.05）；且观察组BMI值显著低于对照组，两组比较差异具有统计学意义（P<0.05）。治疗后，两组患者的FBG、2 h PG、HbA1c水平均较治疗前显著降低，同组治疗前后比较差异具有统计学意义（P<0.05）；治疗后，观察组FBG、2 h PG和HbA1c水平均显著低于对照组，两组比较差异具有统计学意义（P<0.05）。治疗后，两组患者的血清FINS和餐后2 h INS水平均较治疗前显著降低，同组治疗前后比较差异具有统计学意义（P<0.05）；治疗后，观察组的FINS和2 h INS均显著低于对照组，两组比较差异具有统计学意义（P<0.05）。治疗后，两组患者IL-4、IL-6和TNF-α水平均较治疗前显著下降，同组治疗前后比较差异具有统计学意义（P<0.05）；治疗后，观察组的IL-4、IL-6和TNF-α与对照组相比显著降低，两组比较差异具有统计学意义（P<0.05）。治疗后，两组GSH-px和SOD水平均升高，MDA水平均下降，同组治疗前后比较差异具有统计学意义（P<0.05）。治疗后，观察组GSH-px和SOD水平明显高于对照组，MDA水平显著低于对照组，两组比较差异具有统计学意义（P<0.05）。结论 恩格列净联合利格列汀治疗2型糖尿病，可显著降低血糖，改善患者胰岛素抵抗，并显著改善患者的炎症反应和氧化应激水平，且安全性良好。

Objective To investigate the clinical effect of empagliflozin combined with linagliptin in treatment of type 2 diabetes. Methods Patients (120 cases) with type 2 diabetes in Wuhan Asia General Hospital from June 2018 to August 2019 were randomly divided into control group and observation group, each group had 60 cases. Patients in control group were po administered with Linagliptin Tablets, 5mg/time, once daily. Patients in observation group were po administered with Empagliflozin Tablets on the basis of control group, 10 mg/time, once daily. Patients in two groups were treated for 24 weeks. The clinical effects in two groups were observed, and the BMI, FBG, 2 h PG, HbA1c, FINS, 2 h INS, TNF-α, IL-4, IL-6, GSH-px, SOD, and MDA levels before and after treatment were compared. Results After treatment, the total effective rate in the control group and observation group was 86.67% and 95.00%, respectively, the difference between two groups was statistically significant (P<0.05). After treatment, the BMI value in the observation group was significantly lower than that before treatment, and the difference before and after treatment in the same group was statistically significant (P<0.05). After treatment, the BMI value in the observation group was significantly lower than that in the control group, and the difference between the two groups was statistically significant (P<0.05). After treatment, FBG, 2 h PG and HbA1c levels in two groups were significantly lower than thnose before treatment, and the differences before and after treatment in the same group were statistically significant (P<0.05). After treatment, FBG, 2 h PG and HbA1c levels in the observation group were significantly lower than those in the control group, and the differences between the two groups were statistically significant (P<0.05). After treatment, the serum FINS and 2 h post-meal INS levels in two groups were significantly lower than those before treatment, and the difference before and after treatment in the same group was statistically significant (P<0.05). After treatment, the FINS and 2 h INS in the observation group were significantly lower than those in the control group, and the difference between the two groups was statistically significant (P<0.05). After treatment, the levels of IL-4, IL-6 and TNF-α in two groups were significantly lower than those before treatment, and the difference before and after treatment in the same group was statistically significant (P<0.05). After treatment, IL-4, IL-6 and TNF-α levels in the observation group were significantly decreased compared with the control group, and the difference between two groups was statistically significant (P<0.05). After treatment, the levels of GSH-px and SOD in two groups were increased, and the levels of MDA was decreased, the difference before and after treatment in the same group was statistically significant (P<0.05). After treatment, the levels of GSH-px and SOD in the observation group was significantly higher than those in the control group, but the level of MDA was significantly lower than that in the control group, and the difference between two groups was statistically significant (P<0.05). Conclusion Empagliflozin combined with linagliptin in treatment of type 2 diabetes mellitus can significantly reduce blood glucose, improve the insulin resistance, and significantly improve inflammatory response and oxidative stress levels in patients with good safety.

R977

中央高校基本科研业务费专项资金（2017KFYXJJ252）