目的 觀察艾塞那肽注射液治療2型糖尿病合并高血壓的臨床療效。方法 選取2008年1月-2015年1月重慶市沙坪壩區(qū)人民醫(yī)院收治的糖尿病合并高血壓患者97例。所有患者隨機分為對照組(51例)和治療組(46例)。對照組患者給予常規(guī)基礎治療。治療組患者在對照組治療基礎上sc艾塞那肽注射液,起始劑量5μg/次,2次/d,治療4周;然后改用劑量10μg/次,2次/d。兩組患者均治療24周。觀察兩組的血糖、血壓臨床控制的臨床療效,同時比較兩組血糖、血脂、體質(zhì)量指數(shù)(BMI)、糖化血紅蛋白(HbA1c)、血壓、超敏C反應蛋白(Hs-CRP)、脂聯(lián)素和腫瘤壞死因子-α(TNF-α)。結果 治療后,對照組血糖控制總有效率為58.82%,治療組血糖控制總有效率為80.43%,兩組血糖控制總有效率比較差異具有統(tǒng)計學意義(P<0.05)。對照組血壓控制總有效率為49.02%,治療組血壓控制總有效率為91.30%,兩組血壓控制總有效率比較差異具有統(tǒng)計學意義(P<0.05)。治療后,兩組空腹血糖(FPG)、餐后2 h血糖(PPG)、三酰甘油(TG)、HbA1c較治療前顯著下降,同組治療前后差異具有統(tǒng)計學意義(P<0.05),且治療組這些指標的改善程度優(yōu)于對照組,兩組比較差異具有統(tǒng)計學意義(P<0.05)。治療后兩組患者總膽固醇(TC)、BMI比較差異具有統(tǒng)計學意義(P<0.05)。治療后,兩組收縮壓(SBP)、舒張壓(DBP)較治療前顯著下降,同組治療前后差異具有統(tǒng)計學意義(P<0.05),且治療組這些觀察指標的下降程度優(yōu)于對照組,兩組比較差異具有統(tǒng)計學意義(P<0.05)。對照組Hs-CRP、脂聯(lián)素和TNF-α治療前后無明顯差異,但在治療組治療后較治療前顯著降低(P<0.05),且治療組這些觀察指標的下降程度優(yōu)于對照組,兩組比較差異具有統(tǒng)計學意義(P<0.05)。結論 艾塞那肽注射液治療2型糖尿病合并高血壓具有較好的臨床效果,可顯著改善HbA1c、血壓、BMI、Hs-CRP、脂聯(lián)素、TNF-α,具有一定的臨床推廣應用價值。

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.

中華醫(yī)學會臨床醫(yī)學專項資金資助項目(13020120397,13040630448)