目的 分析司美格鲁肽注射液治疗不同体质量指数（BMI）2型糖尿病（T2DM）对糖脂代谢和脂肪因子的影响。 方法 选择2022年5月至2024年5月我院收治的T2DM患者143例纳入研究，按照患者的BMI分为正常组31例（18.5 kg/m² ≤ BMI < 24 kg/m²）、超重组49例（24 kg/m² ≤ BMI < 28 kg/m²）、肥胖组63例（BMI ≥ 28 kg/m²），均根据指南接受常规治疗，同时给予司美格鲁肽注射液治疗，3组均治疗12周。比较3组治疗前、治疗12周后糖代谢、胰岛功能、脂代谢、人体成分、脂肪因子和治疗期间安全性。 结果 与治疗前比较，治疗12周后3组血清空腹血糖（FPG）、餐后2 h血糖（2hPG）、糖化血红蛋白（HbA1c）、胰岛素抵抗指数（HOMA-IR）、血清甘油三酯（TG）、总胆固醇（TC）及低密度脂蛋白胆固醇（LDL-C）水平降低，且肥胖组低于正常组、超重组，超重组低于正常组（P < 0.05）。与治疗前比较，治疗12周后3组空腹C肽（FCP）、餐后2 h C肽（2hCP）、鸢尾素（irisin）、降脂素（adipsin）、网膜素-1（omentin-1）均升高，且肥胖组高于正常组、超重组，超重组高于正常组呈升高趋势（P < 0.05）。与治疗前比较，治疗12周后3组血清高密度脂蛋白胆固醇（HDL-C）水平均升高（P < 0.05）。治疗前超重组、肥胖组BMI、全身总脂肪质量（WBFM）水平高于正常组，肥胖组高于超重组（P < 0.05）；与治疗前比较，治疗12周后超重组、肥胖组BMI、WBFM水平均降低，但肥胖组高于正常组、超重组，超重组高于正常组（P < 0.05）。正常组、超重组、肥胖组治疗期间不良反应发生率依次为12.90%（4/31）、10.20%（5/49）、11.11%（7/63），3组差异无统计学意义（P > 0.05）。 结论 司美格鲁肽注射液可改善不同BMI的T2DM患者糖脂代谢、胰岛功能、脂肪因子，调节人体成分，对超重特别是肥胖的T2DM患者糖脂代谢、胰岛功能以及脂肪因子具有较强的改善作用，未增加安全风险。

Objective To investigate the effects of Semaglutide injection on glycolipid metabolism and adipokine levels in the treatment of type 2 diabetes mellitus （T2DM） patients with varying body mass index （BMI）. Methods A total of 143 patients with T2DM admitted to our hospital between May 2022 and May 2024 were enrolled in this study. Based on their BMI， the patients were categorized into three groups： the normal-weight group （31 cases， 18.5 kg/m² ≤ BMI < 24 kg/m²）， the super-recombinant group （49 cases， 24 kg/m² ≤ BMI < 28 kg/m²）， and the obese group （63 cases， 28 kg/m² ≤ BMI）. 28 kg/m² ≤ BMI）. All participants received standard guideline-based conventional treatment and were additionally administered semaglutide injections for a duration of 12 weeks. The study compared glucose metabolism， islet β-cell function， lipid metabolism， body composition， adipokine levels before treatment and at 12 weeks post-treatment， as well as safety profiles during the treatment period across the three groups. Results After 12 weeks of treatment， the levels of fasting blood glucose （FPG）， 2-hour postprandial blood glucose （2 h PG）， glycated hemoglobin （HbA1c）， insulin resistance index （HOMA-IR）， serum triglycerides （TG）， total cholesterol （TC）， and low-density lipoprotein cholesterol （LDL-C） decreased in all three groups. Specifically， the reductions were more pronounced in the obesity group compared to the normal group and the super-reorganization group， and the super-reorganization group showed intermediate reductions between the obesity and normal groups （P < 0.05）. Conversely， fasting C-peptide （FCP）， 2-hour postprandial C-peptide （2 h CP）， irisin， adipsin， and omentin-1 levels increased in all three groups after treatment， with the greatest increases observed in the obesity group， followed by the super-reorganization group， both of which were significantly higher than the normal group （P < 0.05）. Additionally， high-density lipoprotein cholesterol （HDL-C） levels increased in all three groups after 12 weeks of treatment （P < 0.05）. BaselineBMI and total body fat mass （WBFM） were significantly higher in the obesity group compared to the super-reorganization group， which in turn were higher than the normal group （P < 0.05）. After treatment， BMI and WBFM decreased in both the obesity and super-reorganization groups， but remained significantly higher than in the normal group （P < 0.05）. The incidence of adverse reactions during treatment was 12.90% （4/31）， 10.20% （5/49）， and 11.11% （7/63） in the normal， super-reorganization， and obesity groups， respectively， with no statistically significant differences among the groups （P > 0.05）. Conclusion Smiglutide injection can improve glucose and lipid metabolism， islet function， and adipokine levels in T2DM patients across different BMI categories， while also regulating body composition. It demonstrates a particularly strong improvement effect on glucose and lipid metabolism， islet function， and adipokine levels in overweight and obese T2DM patients. Additionally， smiglutide does not increase safety risks.