利拉鲁肽治疗非酒精性脂肪性肝病合并2型糖尿病患者血脂、血管内皮功能和肝纤维化指标的变化*

doi:10.3969/j.issn.1672-5069.2020.02.014

摘要/Abstract

摘要： 目的探讨应用利拉鲁肽治疗非酒精性脂肪性肝病(NAFLD)合并2型糖尿病(T2DM)患者血脂、血管内皮功能和血清肝纤维化指标的变化。方法 2014年1月～2018年12月我院收治的NAFLD合并T2DM患者90例,被随机分为对照组45例和观察组45例,分别给予二甲双胍或二甲双胍联合利拉鲁肽治疗12周。检测空腹血糖(FPG)、餐后 2 h 血糖(2hPPG)和糖化血红蛋白(HbA1c),使用高分辨超声诊断仪检测肱动脉内径变化,记录血管舒张内径达到最大值所需的时间(T₁)和舌下含化硝酸甘油后血管达最大内径所需的时间(T₂),计算肱动脉血流介导的内皮依赖性血管舒张功能(EDR)和硝酸甘油介导的内皮非依赖性血管舒张功能(END)。采用放射免疫分析法检测血清透明质酸(HA)、层粘连蛋白(LN)、 IV型胶原(CIV)和 III型前胶原(PIIIP)。结果在治疗结束时,观察组和对照组FPG分别为(7.3±1.9)mmol/L对(8.6±1.8)mmol/L,2hPPG分别为(9.8±2.3)mmol/L对(11.4±2.2)mmol/L,HbA1c水平分别为(7.2±1.0)%对(8.3±1.2)%,差异显著(P＜0.05);血清TC分别为(4.8±0.9)mmol/L对(5.6±1.2)mmol/L、TG分别为(1.5±0.4)mmol/L对(2.0±0.6)mmol/L、LDL-C分别为(2.0±0.6)mmol/L对(2.9±0.7)mmol/L和HDL-C分别为(1.6±0.3)mmol/L对(1.3±0.2)mmol/L,差异显著(P＜0.05);T₁分别为(56.1±6.5)s对(62.9±5.8)s,EDR分别为(7.8±1.0)%对(5.2±0.8)%和END分别为(21.3±2.9)%对(17.2±2.5)%,差异显著(P＜0.05);血清HA分别为(70.3±9.2)ng/ml对(85.9±10.3)ng/ml, CIV分别为(50.2±0.7)ng/ml对(67.3±0.9)ng/ml和PIIIP分别为(6.2±0.6)ng/ml对(8.3±0.5)ng/ml,差异显著(P＜0.05)。结论应用利拉鲁肽治疗NAFLD合并2 型糖尿病患者能有效降低血糖,改善血管内皮功能,纠正脂代谢紊乱,对预防糖尿病患者大血管并发症可能有益。

关键词: 非酒精性脂肪性肝病, 2型糖尿病, 利拉鲁肽, 肱动脉, 血管内皮, 治疗

Abstract: Objective Objective The aim of this study was to investigate the efficacy of liraglutide in treatment of patients with nonalcoholic fatty liver disease (NAFLD) complicated by type 2 diabetes mellitus (T2DM). Methods 90 patients with NAFLD and T2DM were recruited in our hospital between January 2014 and December 2018,and were randomly divided into control (n=45) and observation group (n=45). They were treated with metformin or metformin and liraglutide combination for 12 weeks. Fasting blood glucose (FPG) , postprandial 2 h blood glucose (2hPPG) and glycosylated hemoglobin (HbA1c), blood lipid index and serum hyaluronic acid (HA), laminin (LN), type IV collagen (CIV), and type III procollagen (PIIIP) were assayed. The parameters of brachial artery, such as T1 and T2, endothelium-dependent relaxation (EDR) and endothelium-non-dependent relaxation (END) were recorded by high-resolution ultrasound. Results At the end of three-month treatment, the FPGs in the observation and control group were (7.3±1.9) mmol/L vs. (8.6±1.8) mmol/L, and the 2 hPPG were (9.8±2.3) mmol/L vs. (11.4±2.2) mmol, and HbA1c were (7.2±1.0)% vs. (8.3±1.2)%, respectively, all significantly different (P<0.05); serum TC levels were (4.8±0.9) mmol/L vs. (5.6±1.2) mmol/L, TG were (1.5±0.4) mmol/L vs. (2.0±0.6) mmol/L, LDL-C were (2.0±0.6) mmol/L vs. (2.9±0.7) mmol/L, and HDL-C was (1.6±0.3)mmol/L vs. (1.3±0.2)mmol/L, all significantly different (P<0.05); T1 were (56.1±6.5)s vs. (62.9±5.8)s, EDR were (7.8±1.0)% vs. (5.2±0.8)%, and END were (21.3±2.9)% vs. (17.2±2.5)%, all significantly different (P<0.05); serum HA were (70.3±9.2) ng/ml vs. (85.9±10.3) ng/ml, CIV were (50.2±0.7) ng/ml vs. (67.3±0.9) ng/ml, and PIIINP were (6.2±). 0.6) ng/ml vs. (8.3±0.5) ng/ml, all significantly different (P<0.05) in the two groups. Conclusion Liraglutide is efficacious in treatment of patients with NAFLD and mellitus, which could effectively decrease blood sugar levels, improve vascular endothelial functions and correct lipid metabolism disorder.

Key words: Nonalcoholic fatty liver diseases, Type 2 diabetes mellitus, Liraglutide, Brachial artery, Vascular endothelium functions, Therapy

贾晨, 张涛, 王浩, 戚凤君. 利拉鲁肽治疗非酒精性脂肪性肝病合并2型糖尿病患者血脂、血管内皮功能和肝纤维化指标的变化^*[J]. 实用肝脏病杂志, 2020, 23(2): 203-206.

Jia Chen, Zhang Tao, Wang Hao, et al. Efficacy of liraglutide in treatment of patients with nonalcoholic fatty liver disease complicated by type 2 diabetes mellitus[J]. Journal of Practical Hepatology, 2020, 23(2): 203-206.

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利拉鲁肽治疗非酒精性脂肪性肝病合并2型糖尿病患者血脂、血管内皮功能和肝纤维化指标的变化^*

Efficacy of liraglutide in treatment of patients with nonalcoholic fatty liver disease complicated by type 2 diabetes mellitus

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