1、联勤军事医学2 0 2 3年6 月2 8 日第37 卷第6 期Mil Med Jnt Log,Vol.37,No.6,June 28,2023477不同减重方式对2 型糖尿病肥胖患者体脂分布、血糖波动及SFRP5、A PN、LP的调节作用黎俊森，刘丹，黎培爱，崔静【摘要】目的双观察不同减重方式对2 型糖尿病肥胖患者内脏脂肪含量、血糖控制及分泌型卷曲相关蛋白5(secre-torycurlrelatedprotein.5，SFRP5）、脂联素（adiponectin，A PN）、瘦素（leptin，LP)的调节作用，以期寻找一种更适合于糖尿病合并肥胖人群的减重、降糖模式。方法选取2 0 18-0
2、 6/2 0 2 0-12 月作者医院2 型糖尿病肥胖患者195例，以随机数字表法分为试验A组、试验B组、试验C组、试验D组、对照组，每组各39例。试验A组给予限制热量平衡饮食，试验B组给予正常热量饮食联合口服二甲双胍、试验C组给予正常热量饮食联合口服奥利司他、试验D组给予正常热量饮食联合利拉鲁肽，对照组给予正常热量饮食，均治疗3个月。比较5组治疗前、治疗3个月后体质量、体质量指数（bodymass index,BMI)、腰围、内脏脂肪含量、糖化血红蛋白（haemoglobinArc,HbArc)、空腹血糖（fastingblood glucoseFPG)、餐后2 h血糖（postprandi
3、al 2-hourblood glucose,2hPG)、高密度脂蛋白胆固醇（high-density lipoprotein cholester-ol,HDL-C)、低密度脂蛋白胆固醇（lowdensitylipoprotein cholesterolLDL-C)、总胆固醇（totalcholesterol,TC)、甘油三酯(triglycerides，T G)、稳态模型胰岛素抵抗指数(homeostatic model assessment for insulin resistance,HOMA-IR)、稳态模型胰岛细胞功能指数（homeostaticmodel assessment of
4、-cell function，H O M A-）、SFRP5、A PN、LP水平。结果治疗3个月后,患者体质量、BMI、腰围、内脏脂肪含量组间比较,试验C组 试验D组 试验B组 试验A组 对照组（P0.05);H b A r c、FPG、2 h PG 水平组间比较，试验B组和试验D组 试验C组 试验A组 对照组（P0.05)；LD L-C、T C、T G 水平组间比较，试验C组 试验D组 试验B组 试验A组 对照组（P 试验D组 试验B组 试验A组 对照组（P0.05）H O M A-I R、H O M A-水平组间比较，试验B组和试验D组 试验C组 试验A组 对照组（P 试验C组 试验B组
5、试验A组 对照组（P 试验B组 试验A组 对照组(P0.05),LP水平组间比较,试验C组 试验D组 试验B组 试验A组 对照组(P0.05)。结论2 型糖尿病肥胖患者采用二甲双胍、利拉鲁肽治疗降糖、调节胰岛素敏感性作用显著，采用奥利司他治疗减重、降脂效果显著，还可调节SFRP5、A PN、LP表达水平，减轻LP抵抗状态，加速脂肪分解及糖代谢。【关键词】减重方式；肥胖症；2 型糖尿病；内脏脂肪含量；血糖控制；脂联素；分泌型卷曲相关蛋白5；瘦素【中图分类号】R 587.1【文献标识码】Adoi:10.13730/j.issn.2097-2148.2023.06.005Effects of Dif
6、ferent Weight Loss Methods on Body Fat Distribution,Blood Glucose Fluctuation and Regulation of SFRP5,NandDmOoDMellitlsNandpPatientsWithDiabetes MellitusI Junsen,LIU Dan,LI Peiai,CUI Jing.Department of Endocrinology,Sanya Central Hospital(Hainan Provincehird Peoples Hospital),Sanya Hainan 572000,Chi
7、na【A b s t r a c t】Objective To observe the regulatory effects of different weight loss methods on visceral fat content,blood sugar control and secretory curl related protein 5(SFRP5),adiponectin(APN)and leptin(LP)in obese patientswith diabetes,so as to find a more suitable lose weight and hypoglyce
8、mic mode for obese patients with diabetic mellitus.MethodsA total of 195 obese patients with type 2 diabetes mellitus in authors hospital from June 2018 to December2020 were divided into study A group,study B group,study C group,study D group and control group by random num-ber table,with 39 cases i
9、n each.Study A group was given a balanced calorie diet,group B was given a normal calorie dietcombined oral metformin,group C was given a normal calorie diet combined oral orlistat,group D was given a normal cal-orie diet combined liraglutide,and the control group was given the normal calorie diet,w
10、ith treatment for 3 months ineach.The levels of body mass,body mass index(BMI),waist circumference,visceral fat content,haemoglobin Arc(HbA,c),fasting blood glucose(FPG),postprandial 2-hour blood glucose(2hPG),high-density lipoprotein cholesterol【基金项目】海南省卫生健康行业科研项目（2 0 A200372）【作者单位】572000海南三亚，三亚市中心
11、医院（海南省第三人民医院）内分泌科（黎俊森、刘丹、黎培爱、崔静）(HDL-C),low density lipoprotein cholesterol(LDL-C),total cholesterol(TC),triglycerides(TG),homeostaticmodel assessment for insulin resistance(HOMA-IR),ho-meostatic model assessment of-cell function(HOMA-),SFRP5,APN and LP in the 5 groups were comparedMilMed JntLo6,Jun
12、e28,2023联勤军事医学2 0 2 3年6 月2 8 日第37 卷第6 期478before treatments and 3 months after treatments.Results After 3 months of treatments,O Body mass,BMI,waistcircumference and visceral fat content of patients among groups were compared,study C group study D group studyB groupstudy A groupcontrol group(P0.05);
13、T h e l e v e l s o f H b A r c,FPG a n d 2 h PG a mo n g g r o u p s w e r e c o m-pared,study B group and study D groupstudy C group study A group control group(P0.05);T h e l e v e l s o fLDL-C,TC and TG among groups were compared,study C groupstudy D groupstudy B group study A group control grou
14、p(P study D groupstudy Bgroupstudy A groupcontrol group(P0.05);The levels of HOMA-IR and HOMA-among groups were com-pared,study B group and study D groupstudy C groupstudy A group control group(Pstudy C groupstudy B groupstudy A groupcontrolgroup(P study D group study B group study A group control g
15、roup(P0.05),the levels of LP among groups were compared,study C group study Dgroup study B group study A group control group(P0.05),具有可比性，见表1。本研究经作者医院医学伦理委员会批准2 0 18（科研）第（9)号。表1患者一般资料比较（n=39/组）Table 1Comparison of general data of patients(n=39/group)项目对照组试验A组试验B组试验C组试验D组F/x2值P值性别 n(%)4.2260.376男15(3
16、8.46)22(56.41)20(51.28)23(58.97)18(46.15)女24(61.54)17(43.59)19(48.72)16(41.03)21(53.85)年龄（岁，工土s)43.027.8045.02 7.1644.397.4547.18 6.8944.79 6.971.6670.159病程（年，土s)2.80 0.603.02 0.642.78 0.552.95 0.603.05 0.591.6920.153内脏脂肪面积（cm,土s）187.96 26.39179.45 25.26184.59 28.84177.56 26.65183.98 27.150.9430.441全身脂肪百分比（%，工土s）36.085.5434.15 5.0635.065.2133.895.4035.39 4.771.6670.327四肢骨骼肌指数（kg/m，s)8.090.747.920.728.260.627.94 0.648.220.602.1330.0781.2纳入与排除标准1.2.1纳人标准符合中国成人肥胖症防治专家共识6 中肥胖症诊断标准者；符合中国2 型糖尿病防治指南(2