【摘要】 目的   评价利拉鲁肽治疗不同T2DM病程的肥胖/超重患者的临床疗效及其安全性。  方法   入选口服降糖药物(OADs)血糖控制不佳的肥胖/超重T2DM患者78例，分为病程≤5年组和病程＞5年组。两组在原治疗方案的基础上加用利拉鲁肽，治疗14周，比较两组临床疗效和不良反应。  结果   与治疗前相比，两组HbA1c[病程≤5年组: (8.61±0.76)% vs                ( 7.21±0.58 )%；病程＞5年组: (8.84±1.07)% vs  (7.81±1.05 )%]、FPG[病程≤5年组: (8.93±0.84) vs ( 6.81±1.16)  mmol/L; 病程＞5年组: (9.16±1.02) vs (8.08±1.44) mmol/L]、2 hPG [病程≤5年组: (14.09±3.36) vs (10.67±1.54) mmol/L;病程＞5年组: (15.29±3.46) vs ( 11.26±2.05)  mmol/L]、BMI[病程≤5年组: (28.62±2.81) vs (26.73±2.83)kg/m2;病程＞5年组: (27.88±2.14) vs (27.05±2.47)  kg/m2]下降；稳态模型胰岛β细胞功能指数（HOMA-β）[病程≤5年组: (33.77±8.04) vs (51.63±13.26);病程＞5年组: (28.24±6.24) vs (37.10±10.41)]升高（P＜0.01）。病程≤5年组HOMA-IR[ (3.59±0.81) vs (2.59±1.27)]降低、胰岛素敏感性指数（ISI）[ (-4.36±0.24) vs (-3.94±0.51)]升高（P＜0.01）。与病程＞5年组比较，病程≤5年组 FPG、HbA1c、HOMA-IR降低，HOMA-β升高（P＜0.01）。 两组低血糖发生率比较，差异无统计学意义（P＞0.05 ）。  结论   利拉鲁肽治疗不同T2DM糖尿病病程的肥胖/超重患者均可降低血糖、减轻体重，并改善胰岛β细胞功能；在糖尿病早期开始应用利拉鲁肽，血糖下降和胰岛β细胞功能改善更为明显。
      【关键词】 糖尿病，2型；肥胖；利拉鲁肽； 病程

         Clinical efficacy and safety of liraglutide in the treatment of obese or overweight patients with different duration of T2DM

       【Abstract】  Objective   To assess the clinical efficacy and safety of liraglutide in the treatment of obese or overweight patients with different duration of type 2 diabetes (T2DM).  Methods  A total of 78 obese or overweight T2DM patients in poor glycemic control by oral antidiabetics (OADs) were selected and divided into two groups: short duration group (≤5 years, n=39) and long duration group (>5 years, n=39). Patients in both groups were treated with liraglutide on the basis of original treatment regimen for 14 weeks. Clinical efficacy and adverse reactions were compared between two groups.  Results  HbA1c, FPG, 2 hPG and BMI of both groups significantly decreased and homeostatic model islet β-cell function index (HOMA-β) significantly increased after treatment with liraglutide  (P＜0.01). Homeostatic model insulin resistance index (HOMA-IR) significantly decreased and insulin sensitive index (ISI)  significantly increased in short duration group after treatment with liraglutide (P＜0.01).  The decrease of HbA1c, FPG and HOMA-IR and the increase of HOMA-β in short duration group  were more obvious than in long duration group (P<0.01). There was no significant difference in the incidence of hypoglycemia（P＞0.05）. Severe hypoglycemia events were not observed in both groups.  Conclusion  Liraglutide can decrease blood glucose, reduce body weight and improve the function of islet β cell  in obese or overweight patients with different duration of T2DM. The efficacy of liraglutide was more significant when used at early stage of T2DM. 

      【Key words】 Diabetes mellitus, type 2; obesity; Liraglutide ；duration