二甲双胍联合双歧杆菌三联活菌胶囊治疗非酒精性脂肪性肝病患者疗效及血清IRS1、IRS2和GLUT4的变化

doi:10.3969/j.issn.1672-5069.2021.01.017

摘要/Abstract

摘要： 目的应用二甲双胍联合双歧杆菌三联活菌胶囊治疗非酒精性脂肪性肝病(NAFLD)患者,观察疗效及其血清避光孵育胰岛素受体底物1(IRS1)、IRS2和葡萄糖转运蛋白-4(GLUT4)的变化。方法 2018年6月～2019年12月我院收治的NAFLD患者70例,采用随机数字表法分为对照组35例和观察组35例,分别给予盐酸二甲双胍或二甲双胍联合双歧杆菌三联活菌胶囊治疗3个月。采用荧光定量PCR法检测外周血IRS1、IRS2和GLUT4 mRNA水平,采用化学发光免疫分析法检测血清高敏C反应蛋白(hs-CRP)、白介素-6(IL-6)和IL-10水平。结果在治疗3个月末,观察组超声检查脂肪肝改善率为91.4%,显著高于对照组的68.6%(P<0.05);观察组血清天门冬氨酸氨基转移酶(AST)水平为(23.9±9.7)U/L,显著低于对照组【(34.5±11.2)U/L,P<0.05】,血清丙氨酸氨基转移酶(ALT)水平为(45.5±12.3)U/L,显著低于对照组【(66.3±16.8)U/L,P<0.05】,血清谷氨酰转肽酶(GGT)水平为(66.9±11.9)U/L,显著低于对照组【(77.8±15.4)U/L,P<0.05】;外周血IRS1 mRNA水平为(2.1±0.2),显著高于对照组【(1.4±0.2),P<0.05】,外周血IRS2 mRNA水平为(2.3±0.4),显著高于对照组【(1.5±0.2),P<0.05】,外周血GLUT4 mRNA水平为(2.5±0.4),显著高于对照组【(1.8±0.3),P<0.05】;血清hs-CRP水平为(3.4±0.7)mg/L,显著低于对照组【(4.3±0.9)mg/L,P<0.05】,血清IL-6水平为(26.9±7.4)ng/L,显著低于对照组【(33.6±8.9)ng/L,P<0.05】,血清IL-10水平为(46.5±12.8)ng/L,显著低于对照组【(63.0±14.4)ng/L,P<0.05】。结论应用二甲双胍联合双歧杆菌三联活菌胶囊治疗NAFLD患者能短期改善脂肪肝表现,可能与降低了外周血IRS1、IRS2和GLUT4 mRNA水平和抑制了炎症反应,从而可能改善了胰岛素抵抗有关。

关键词: 非酒精性脂肪性肝病, 双歧杆菌三联活菌, 二甲双胍, 避光孵育胰岛素受体底物1, 葡萄糖转运蛋白-4, 治疗

Abstract: Objective The aim of this study was to investigate the therapeutic efficacy of bifidobacterium triple viable capsule and metformin in the treatment of patients with nonalcoholic fatty liver disease (NAFLD) and the changes of blood dark incubation of insulin receptor substrate 1(IRS1), IRS2 and glucose transporter -4(GLUT4) mRNA. Methods 70 patients with NAFLD were enrolled in our hospital between June 2018 and December 2019,and were randomly divided into control (n=35) and observation (n=35), receiving metformin hydrochloride or bifidobacterium triple viable capsules at base of metformin for three months. Peripheral blood IRS1, IRS2 and GLUT4mRNA were assayed by RT-PCR, and serum highly sensitive c-reactive protein (hs-CRP), interleukin -6 (IL-6) and IL-10 levels were also detected. Results At the end of three month treatment, the total fatty liver improvement rate in the observation group was 91.4%, which was significantly higher than that in the control group (68.6%, P<0.05); serum aspartate aminotransferase (AST) level in the observation group was (23.9±9.7) U/L, significantly lower than that in the control group , serum alanine aminotransferase (ALT) level was (45.5±12.3) U/L, much lower than that in the control group , and serum glutamyltranspeptidase (GGT) level was (66.9±11.9) U/L, significantly lower than that in the control group ; blood IRS1 mRNA was (2.1±0.2), which was much higher than that in the control group , peripheral blood IRS2 mRNA level was (2.3±0.4), which was significantly higher than that in the control group , and peripheral blood GLUT4 mRNA level was (2.5±0.4), which was also significantly higher than that in the control group ; serum hs-CRP level was (3.4±0.7) mg/L, significantly lower than that in the control group , serum interleukin-6(IL-6) level was (26.9±7.4)ng/L, significantly lower than that in the control group , and serum IL-10 level was (46.5±12.8)ng/L, significantly lower than that in the control group .Conclusion The combination of bifidobacterium triple viable capsule and metformin in treatment of patients with NAFLD could effectively improve the hepatic steatosis, which might be related to the elevation of peripheral blood IRS1, IRS2 and GLUT4 and inhibition of serum inflammatory factors.

Key words: Nonalcoholic fatty liver diseases, Bifidobacterium, Metformin, Incubating insulin receptor substrate 1 in dark, Glucose transporter -4, Therapy

陈金玉, 郭晓霞, 钟晓妮. 二甲双胍联合双歧杆菌三联活菌胶囊治疗非酒精性脂肪性肝病患者疗效及血清IRS1、IRS2和GLUT4的变化[J]. 实用肝脏病杂志, 2021, 24(1): 63-66.

Chen Jinyu, Guo Xiaoxia, Zhong Xiaoni. Efficacy of bifidobacterium triple viable capsuleand metformin in treatment of patients with nonalcoholic fatty liver disease[J]. Journal of Practical Hepatology, 2021, 24(1): 63-66.

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