目的 探討利拉魯肽聯(lián)合胰島素治療肥胖2型糖尿病患者的臨床療效。方法 選取云南省第三人民醫(yī)院2017年1月—2017年6月收治的肥胖2型糖尿病患者95例，按治療方法分為對(duì)照組47例、觀察組48例。對(duì)照組在口服藥物不變的基礎(chǔ)上使用胰島素治療，觀察組在口服藥物不變的基礎(chǔ)上使用原胰島素劑量暫減1/3，聯(lián)合使用利拉魯肽進(jìn)行治療。兩組患者均治療3個(gè)月，每周電話隨訪一次指導(dǎo)胰島素劑量調(diào)整。比較兩組治療前后血糖、血脂、胰島功能相關(guān)指標(biāo)的變化，比較兩組治療期間不良反應(yīng)的發(fā)生情況。結(jié)果 兩組治療前空腹血糖（FBG）、餐后2 h血糖（2hPG）、糖化血紅蛋白（HbA1c）間無(wú)顯著差異，治療后兩組FBG、2hPG、HbA1c均較治療前顯著降低（P<0.05），且觀察組顯著低于對(duì)照組（P<0.05）。兩組治療前空腹C肽（FCP）、餐后2 h C肽（PCP）、胰島素抵抗指數(shù)（HOMA-IR）、胰島β細(xì)胞功能指數(shù)（HOMA-β）無(wú)顯著差異；治療后兩組FCP、PCP、HOMA-IR均較治療前顯著降低（P<0.05）、HOMA-β均較治療前顯著升高（P<0.05）；且觀察組比對(duì)照組更明顯，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。兩組治療前總膽固醇（TC）、三酰甘油（TG）、高密度脂蛋白膽固醇（HDL-C）、低密度脂蛋白膽固醇（LDL-C）無(wú)顯著差異，治療后兩組TC、TG、LDL-C均顯著降低（P<0.05）、HDL-C均顯著升高（P<0.05）；且觀察組比對(duì)照組更明顯，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。對(duì)照組、觀察組患者的不良反應(yīng)發(fā)生率分別是14.89%、12.5%，兩組不良反應(yīng)的發(fā)生率間無(wú)統(tǒng)計(jì)學(xué)差異。結(jié)論 利拉魯肽聯(lián)合胰島素治療肥胖2型糖尿病是安全有效的，可顯著控制血糖、血脂，改善胰島功能，值得臨床應(yīng)用推廣。

Objective To explore the clinical efficacy of liraglutide combined with insulin in the treatment of obese type 2 diabetic patients.Methods Selected 95 patients with type 2 diabetes mellitus in our hospital from January 2017 to June 2017. All patients were divided into control group and observation group by treatment methods, each of group of 47, 48 cases. The control group was treated with insulin on the basis of unchanged oral drug. The observation group used 1/3 insulin on the basis of unchanged oral drug, combined with liraglutide for treatment. The changes of related indexs of blood glucose, blood lipid, inslet function were compared between the two groups. The incidences of adverse reactions of the two groups were compared.Results There was no significant difference between FBG, 2hPG and HbA1c before treatment in both groups. After treatment, the relevant indicators of blood glucose in both groups were significantly lower (P<0.05), and the observation group was more obvious than the control group (P<0.05). There were no significant differences in FCP, PCP, HOMA-IR and HOMA-β between the two groups before treatment. The levels of FCP, PCP and HOMA-IR in the two groups were significantly increased (P<0.05) and HOMA-β significantly decreased after treatment (P<0.05), and the observation group was more obvious than the control group (P<0.05). There was no significant difference in TC, TG, HDL-C and LDL-C between the two groups before treatment. The levels of TC, TG and LDL-C in the two groups were significantly lower (P<0.05) and HDL-C significantly increased after treatment (P<0.05), and the observation group was more obvious than the control group (P<0.05). The incidence of adverse reactions in the control group and observation group were 14.89 and 12.5% respectively. There was no significant difference between the two groups in the incidence of adverse reactions. Conclusions Liraglutide combined with insulin in the treatment of obese T2DM is safe and effective, can significantly control blood glucose, blood lipids, improve pancreatic islet function, it is worth promoting the clinical application.