目的 比較度拉糖肽注射液和利拉魯注射液肽聯(lián)合鹽酸二甲雙胍片治療超重及肥胖2型糖尿病患者的臨床療效。方法 選擇2019年8月—2020年8月就診于天津市第二醫(yī)院門診的68例超重及肥胖2型糖尿病患者，采用隨機(jī)數(shù)字表法將所有患者分為對(duì)照組和治療組，每組各34例。所有患者口服鹽酸二甲雙胍片，1 500 mg/d。對(duì)照組給予利拉魯肽注射液，起始劑量為每日7:00皮下注射0.6 mg，根據(jù)血糖水平和患者的反應(yīng)逐步增加劑量，最大劑量為1.8 mg/d。治療組給予度拉糖肽注射液，起始劑量為每10天于7:00皮下注射度拉糖肽注射液1.5 mg，根據(jù)血糖和患者的耐受情況逐步調(diào)整為每周固定一天7:00皮下注射度拉糖肽注射液1.5 mg。兩組患者連續(xù)治療24周。觀察兩組患者的臨床療效，比較兩組患者治療前后的血糖、糖化血紅蛋白（HbA1c）、體質(zhì)量指數(shù)（BMI）、胰島素抵抗指數(shù)（HOMA-IR）的變化。結(jié)果 治療后，對(duì)照組和治療組總有效率分別為94.12%、97.06%，治療組總有效率高于對(duì)照組，但兩組總有效率比較差異無(wú)統(tǒng)計(jì)學(xué)意義。治療后，兩組空腹血糖（FPG）、餐后2小時(shí)血糖（2 h PPG）、HbA1c、BMI均顯著低于治療前（P<0.05）；治療后兩組FPG、2 h PPG、HbA1c、BMI比較差異無(wú)統(tǒng)計(jì)學(xué)意義。治療后，兩組HOMA-IR均低于治療前，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）；治療后兩組HOMA-IR比較差異無(wú)統(tǒng)計(jì)學(xué)意義。兩組間HOMA-IR下降值比較無(wú)統(tǒng)計(jì)學(xué)差異。結(jié)論 度拉糖肽注射液和利拉魯肽注射液聯(lián)合鹽酸二甲雙胍片治療超重及肥胖2型糖尿病的療效顯著，降糖同時(shí)減重，改善胰島素抵抗，值得推廣。

Objective To compare the efficacy of Dulaglutide Injection and Liraglutide Injection combined with Metformin Hydrochloride Tablets in treatment of overweight and obesity type 2 diabetes mellitus.Methods Patients (68 cases) with overweight and obesity type 2 diabetes mellitus in Tianjin Second Hospital from August 2019 to August 2020 were randomly divided into control and treatment groups, and each group had 34 cases. All patients were po administered with Metformin Hydrochloride Tablets, 1 500 mg/d. Patients in the control group were given Liraglutide Injection, the initial dose was subcutaneous injection of 0.6 mg at 7:00 daily, the dose was gradually increased according to the blood glucose level and the patient’s reaction, and the maximum dose was 1.8 mg/d. Patients in the treatment group were given Dulaglutide Injection, and the initial dose was subcutaneous injection of 1.5 mg at 7:00 every 10 days. According to the blood glucose and tolerance of patients, it was gradually adjusted to subcutaneous injection of 1.5 mg at 7:00 every week. Patients in two groups were treated for 24 weeks. After treatment, the clinical efficacies were evaluated, and the changes of blood glucose, HbA1c, BMI, and HOMA-IR were compared between the two groups before and after treatment.Results After treatment, the total effective rates of the control group and the treatment group were 94.12% and 97.06%, respectively, and there was no significant difference between the two groups. After treatment, the FPG, 2 h PPG, HbA1c, and BMI of two groups were significantly lower than those before treatment (P<0.05). There was no significant difference in FPG, 2 h PPG, HbA1c, and BMI between two groups after treatment. After treatment, the HOMA-IR of two groups was lower than before treatment, and the difference was statistically significant (P<0.05). There was no significant difference in HOMA-IR between two groups after treatment. There was no significant difference in the decrease of HOMA-IR between two groups.Conclusion Dulaglutide Injection and Liraglutide Injection combined with Metformin Hydrochloride Tablets has clinical effect in treatment of overweight and obesity type 2 diabetes mellitus, can reduce blood sugar and weight, improve insulin resistance, which is worthy of promotion.

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