目的 探究二甲雙胍聯(lián)合維格列汀治療肥胖型2型糖尿病的臨床療效。方法 選取2010年3月—2013年2月來(lái)重慶市忠縣人民醫(yī)院就診的肥胖型2型糖尿病患者106例，依據(jù)分層隨機(jī)分組法將患者分為治療組（53例）和對(duì)照組（53例）。對(duì)照組給予常規(guī)療法，隨餐同服二甲雙胍0.5 g/次，2次/d，后依據(jù)病情以0.5 g/2周逐漸增量，最大劑量不超過(guò)2.5 g/d，同時(shí)早餐前口服吡格列酮，起始劑量15 mg/d，最大劑量不超過(guò)45 mg/d；治療組口服二甲雙胍，用法用量同對(duì)照組，同時(shí)隨餐口服維格列汀50 mg/次，2次/d。兩組患者均治療6個(gè)月。比較兩組患者治療前后體質(zhì)量指數(shù)（BMI）、糖化血紅蛋白（HbA1c）、糖化白蛋白（GSP）、空腹血糖（FBG）、餐后2小時(shí)血糖（2hPBG）、胰高血糖素樣肽-1（GLP-1）、三酰甘油（TG）、總膽固醇（TC）、低密度脂蛋白膽固醇（LDL-C）、高密度脂蛋白膽固醇（HDL-C）、治療總有效率，同時(shí)觀察兩組患者可能出現(xiàn)的不良反應(yīng)。結(jié)果 治療后兩組患者的BMI、HbA1c、GSP、FBG、2hPBG、TG、TC及LDL-C均較治療前有所下降，差異均有統(tǒng)計(jì)學(xué)意義（P<0.05）；治療后，治療組患者的BMI、HbA1c、GSP、FBG、2hPBG、TG、TC及LDL-C均較對(duì)照組下降更加明顯，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后治療組患者的GLP-1和HDL-C均明顯高于對(duì)照組，兩組比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，治療組和對(duì)照組的總有效率分別為98.11%、86.79%，兩組比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論 二甲雙胍聯(lián)合維格列汀治療肥胖型2型糖尿病可有效控制患者的血糖和體質(zhì)量，且不增加低血糖風(fēng)險(xiǎn)，同時(shí)也可達(dá)到降低血脂的作用，值得臨床推廣應(yīng)用。

Objective To explore the efficacy of metformin combined with vildagliptin in treatment of type 2 diabetes with obesity. Methods Obese patients (106 cases) with type 2 diabetes who came to Zhongxian People's Hospital of Chongqing City for treatment from March 2010 to February 2013 were divided into treatment and control groups according to the stratified randomization method (n = 53). The patients in the control group were given metformin (0.5 g/time, twice daily) with meals at the basis of conventional therapy, in the 0.5 g/2 weeks gradual increments based on the condition of disease and the maximum dosage does not exceed 2.5 g/d. At the same time, they were po administered with pioglitazone before breakfast, at the starting dosage of 15 mg/d and the maximum dosage should not exceed 45 mg daily. The patients in the treatment group were given metformin, with the same usage and dosage as the control group. The patients in the treatment group were given vildagliptin with meals, 50 mg/time, twice daily. The patients in the two groups were treated for 6 months. The indexes of two groups such as body mass index (BMI), glycated hemoglobin (HbA1c), glycated albumin (GSP), fasting blood glucose (FBG), 2-hour postprandial glucose (2hPBG ), glucagon-like peptide-1 (GLP-1), triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), and total effective rate were compared. Adverse reactions of two groups were observed. Results After treatment, BMI, HbA1c, GSP, FBG, 2hPBG, TG, TC, and LDL-C of the two groups decreased, and the difference had statistical significance (P < 0.05). After treatment, BMI, HbA1c, GSP, FBG, 2hPBG, TG, TC, and LDL-C in the treatment group dropped off more sharply than those in the control group, and the difference between the two groups was statistically significant (P < 0.05). After the treatment, the total effective rates in the treatment and control groups were 98.11% and 86.79%. And there were significant differences between the two groups (P < 0.05). Conclusion Metformin combined with vildagliptin in treatment of type 2 diabetes with obesity can effectively control the blood sugar and body quality of patients, and does not increase the risk of hypoglycemia, at the same time it also can reduce blood fat, which is worthy of clinical popularization and application.

國(guó)家自然科學(xué)基金資助項(xiàng)目（30971129）