二甲双胍联合吡格列酮治疗非酒精性脂肪性肝病合并2型糖尿病患者疗效研究*

doi:10.3969/j.issn.1672-5069.2022.06.012

摘要/Abstract

摘要： 目的探讨应用二甲双胍联合吡格列酮治疗非酒精性脂肪性肝病(NAFLD)合并2型糖尿病(T2DM)患者的效果。方法 2018年10月～2020年10月我院收治的NAFLD合并T2DM患者86例,采用随机数字表法分为对照组43例和观察组43例,分别给予二甲双胍或二甲双胍联合吡格列酮治疗24 w。常规检测谷丙转氨酶(ALT)、谷草转氨酶(AST)、谷氨酰转肽酶(GGT)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C)、空腹血糖(FPG)、糖化血红蛋白(HbA1c);采用电化学发光法检测血清空腹胰岛素(FINS),并计算稳态模型胰岛素抵抗指数(HOMA-IR)。结果在治疗24 w末,观察组血清AST水平为(37.9±4.2)U/L,显著低于对照组【(50.7±3.8)U/L,P<0.05】,GGT水平为(64.1±6.2)U/L,显著低于对照组【(73.1±7.0)U/L,P<0.05】;FPG水平为(6.0±1.2)mmol/L,显著低于对照组【(6.8±1.5)mmol/L,P<0.05】,HbA1c水平为(7.2±1.1)%,显著低于对照组【(7.7±1.3)%,P<0.05】,HOMA-IR水平为(2.4±0.5),显著低于对照组【(2.9±0.5),P<0.05】;血清TG水平为(2.2±0.5)mmol/L,显著低于对照组【(2.6±0.4)mmol/L,P<0.05】,LDL-C水平为(3.1±0.6)mmol/L,显著低于对照组【(3.5±0.8)mmol/L,P<0.05】,而血清HDL-C水平为(1.5±0.3)mmol/L,显著高于对照组【(1.2±0.2)mmol/L,P<0.05】。结论应用二甲双胍联合吡格列酮治疗NAFLD合并T2DM患者能有效降低血糖水平,纠正脂质代谢紊乱和胰岛素抵抗,在改善患者肝功能方面显示出有意义的苗头,值得进一步深入探讨。

关键词: 非酒精性脂肪性肝病, 2型糖尿病, 二甲双胍, 吡格列酮, 胰岛素抵抗, 治疗

Abstract: Objective The aim of this clinical trial was to observe the short-term observation of metformin and pioglitazone combination in treatment of patients with non-alcoholic fatty liver diseases (NAFLD) and diabetes mellitus type 2 (T2DM). Methods 86 patients with NAFLD and T2DM were enrolled in our hospital between October 2018 and October 2020, and were divided randomly into control (n=43) and observation group (n=43). The patients in the control received metformin therapy and those in the observation were treated by metformin and pioglitazone combination therapy. The regimen lasted for 24 weeks. Serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), glutamyl transferase (GGT), total cholesterol (TC), triacylglycerol (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), fasting blood glucose (FPG) and glycosylated hemoglobin (HbA1c) were detected. Serum fasting insulin (FINS) level was detected by electrochemiluminescence method, and the homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. Results At the end of 24 week treatment and in the observation group, serum AST level was significantly lower than that in the control group [(37.9±4.2) U/L vs. (50.7±3.8) U/L, P<0.05], and serum GGT level was significantly lower than that in control group [(64.1±6.2) U/L vs. (73.1±7.0) U/L, P<0.05]; FPG level in observation group was significantly lower than that in control group [(6.0±1.2) mmol/L vs. (6.8± 1.5) mmol/L, P<0.05], HbA1c level was significantly lower than that in control group [(7.2±1.1)% vs. (7.7±1.3)%, P<0.05], and HOMA-IR level was significantly lower than that in control group [(2.4±0.5) vs. (2.9±0.5), P<0.05]; serum TG level was significantly lower than that in control group [(2.2±0.5) mmol/L vs. (2.6±0.4) mmol/L, P<0.05], LDL-C level was significantly lower than that in control group [(3.1±0.6) mmol/L vs. (3.5±0.8) mmol/L, P<0.05], while serum HDL-C level was significantly higher than that in control group [(1.5±0.3) mmol/L vs. (1.2±0.2) mmol/L, P<0.05]. Conclusion The application of metformin and pioglitazone combination in the treatment of patients with NAFLD and T2DM could effectively decrease blood glucose and insulin resistance levels, correct lipid metabolism disorders, which warrants further clinical investigation.

Key words: Non-alcoholic fatty liver disease, Type 2 diabetes mellitus, Metformin, Pioglitazone, Insulin resistance, Therapy

孙凌, 杭玮, 邓国忠. 二甲双胍联合吡格列酮治疗非酒精性脂肪性肝病合并2型糖尿病患者疗效研究^*[J]. 实用肝脏病杂志, 2022, 25(6): 804-807.

Sun Ling, Hang Wei, Deng Guozhong. Short-term observation of metformin and pioglitazone combination in treatment of patients with non-alcoholic fatty liver diseases and diabetes mellitus type 2[J]. Journal of Practical Hepatology, 2022, 25(6): 804-807.

参考文献

[1] Schonfels W, Beckmann JH, Ahrens M, et al. Histologic improvement of NAFLD in patients with obesity after bariatric surgery based on standardized NAS (NAFLD activity score). Surg Obes Relat Dis, 2018, 14(10):1607-1616.
[2] Koch LK, Yeh MM. Nonalcoholic fatty liver disease (NAFLD):diagnosis, pitfalls, and staging. Ann Diagn Pathol, 2018, 37(1):83-90.
[3] Eslam M , Valenti L , Romeo S . Genetics and epigenetics of NAFLD and NASH: Clinical impact. J Hepatol, 2018, 28(2):268-279.
[4] Khan RS, Bril F, Cusi K,et al. Modulation of insulin resistance in nonalcoholic fatty liver disease. Hepatology, 2019, 70(2):711-724.
[5] Tilg H, Moschen AR, Roden M. NAFLD and diabetes mellitus. Nat Rev Gastroenterol Hepatol, 2017, 14(1):32-42.
[6] 石翠翠, 范建高. 美国非酒精性脂肪性肝病诊疗指南解读. 实用肝脏病杂志, 2017, 20(5):646-648.
[7] 中华医学会肝病学分会脂肪肝和酒精性肝病学组, 中国医师协会脂肪性肝病专家委员会. 非酒精性脂肪性肝病防治指南(2018年更新版).实用肝脏病杂志, 2018, 21(2):177-186.
[8] 中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2017年版). 中华糖尿病杂志, 2018, 10(1):4-67.
[9] Chitturi S, Wong VW, Farrell G. Nonalcoholic fatty liver in Asia: Firmly entrenched and rapidly gaining ground. J Gastroenterol Hepatol, 2011, 26(1) 1:163-172.
[10] Younossi ZM, Golabi P, Avila L,et al. The global epidemiology of NAFLD and NASH in patients with type 2 diabetes: A systematic review and meta-analysis. J Hepatol, 2019, 71(4):793-801.
[11] Bril F. Nonalcoholic fatty liver disease in type 2 diabetes: awareness is the first step toward change. Hepatobiliary Surg Nutr, 2020, 9(4):493-496.
[12] 梁小丽, 邝继孙, 刘秋莉,等. 非诺贝特联合热量限制饮食治疗非酒精性脂肪性肝病合并2型糖尿病患者疗效研究. 实用肝脏病杂志, 2021, 24(1):51-54.
[13] Dougherty JA, Guirguis E, Thornby KA. Asystematic review of newer antidiabetic agents in the treatment of nonalcoholic fatty liver disease. Ann Pharmacother, 2021, 55(1):65-79.
[14] Musso G, Cassader M, Paschetta E,et al. Pioglitazone for advanced fibrosis in nonalcoholic steatohepatitis: New evidence, new challenges. Hepatology, 2017, 65(3):1058-1061.
[15] 南月敏, 付娜, 李文聪,等. 2017美国非酒精性脂肪性肝病诊断与管理指南解读. 中华肝脏病杂志, 2017, 25(9):687-694.
[16] Kleiner DE. Histopathology, grading and staging of nonalcoholic fatty liver disease. Minerva Gastroenterol Dietol, 2017, 64(1):28-38.
[17] Byrne CD, Targher G. NAFLD: a multisystem disease. J Hepatol, 2015, 62(1):47-64.
[18] Ahmadian M, Suh JM, Hah N,et al. PPARγ signaling and metabolism: the good, the bad and the future. Nat Med, 2013, 19(5):557-566.
[19] 庞晓宁, 刘彦君. 利拉鲁肽、西他列汀和吡格列酮治疗NAFLD合并2型糖尿病患者疗效初步比较研究. 实用肝脏病杂志, 2017, 20(5):604-605.
[20] 徐萍, 戴慧芬, 厉有名,等. 吡格列酮治疗大鼠非酒精性脂肪性肝病的研究. 中华消化杂志, 2006, 26(10)678-681.
[21] Cusi K, Orsak B, Bril F,et al. Long-term pioglitazone treatment for patients with nonalcoholic steatohepatitis and prediabetes or type 2 diabetes mellitus: a randomized trial. Ann Intern Med, 2016, 165(5):305-315.
[22] Sumida Y, Yoneda M, Ogawa Y,et al. Current and new pharmacotherapy options for non-alcoholic steatohepatitis. Expert Opin Pharmacother, 2020, 21(8):953-967.
[23] 李延兵, 廖志红, 黄知敏,等. 吡格列酮和二甲双胍对2型糖尿病胰岛素抵抗的影响. 中华内分泌代谢杂志, 2004, 20(1):30-32.
[24] Defronzo RA, Mehta RJ, Schnure JJ. Pleiotropic effects of thiazolidinediones: implications for the treatment of patients with type 2 diabetes mellitus. Hosp Pract, 2013, 41(2):132-147.
[25] DeFronzo RA, Inzucchi S, Abdul-Ghani M. Pioglitazone: The forgotten, cost-effective cardioprotective drug for type 2 diabetes. Diab Vasc Dis Res, 2019, 16(2):133-143.

二甲双胍联合吡格列酮治疗非酒精性脂肪性肝病合并2型糖尿病患者疗效研究^*

Short-term observation of metformin and pioglitazone combination in treatment of patients with non-alcoholic fatty liver diseases and diabetes mellitus type 2

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	韩芳, 李佳峥, 南月敏. 肝硬化并发急性肾损伤诊治进展[J]. 实用肝脏病杂志, 2022, 25(6): 768-771.
[2]	李向阳, 丁光伟, 靳铭. 恩替卡韦治疗慢性乙型肝炎合并NAFLD患者临床疗效研究^*[J]. 实用肝脏病杂志, 2022, 25(6): 776-779.
[3]	吴凤萍, 崔丹丹, 王怡恺, 李梅, 刘晨瑞, 南希, 贾晓黎, 党双锁. 血清BAFF预测聚乙二醇干扰素-α治疗非活动性HBsAg携带者临床治愈的效能分析^*[J]. 实用肝脏病杂志, 2022, 25(6): 780-783.
[4]	许海玲, 秦刚, 薛红, 章颖. 艾尔巴韦/格拉瑞韦治疗基因1b型慢性丙型肝炎患者疗效研究^*[J]. 实用肝脏病杂志, 2022, 25(6): 788-791.
[5]	赵资德, 吴令杰, 张海生, 陈瑞烈. 纠正低蛋白血症减少抗结核药物性肝损伤发生临床研究^*[J]. 实用肝脏病杂志, 2022, 25(6): 792-795.
[6]	孙峥, 王笑烨, 袁景, 梁丽. 达格列净联合利拉鲁肽治疗非酒精性脂肪性肝病合并2型糖尿病患者短期疗效研究^*[J]. 实用肝脏病杂志, 2022, 25(6): 796-799.
[7]	蔡勇, 李璟, 欧琴. 2型糖尿病合并非酒精性脂肪性肝病患者血清网膜素、视黄醇结合蛋白4和Ⅰ型原胶原氨基端前肽水平及意义分析^*[J]. 实用肝脏病杂志, 2022, 25(6): 800-803.
[8]	王晓华, 曾雅琳, 郭萃蓉. 非酒精性脂肪性肝病进展性肝纤维化患者空腹血糖受损和胰岛素抵抗调查^*[J]. 实用肝脏病杂志, 2022, 25(6): 812-815.
[9]	樊叶, 张喜梅, 张岩. 非酒精性脂肪性肝病患者血清胱抑素C、脂蛋白α和nesfatin-1水平变化及其临床意义探讨^*[J]. 实用肝脏病杂志, 2022, 25(6): 816-819.
[10]	贺锦帆, 姚佳, 赵强, 王娟, 白津佳, 赵凝慧. 双重血浆分子吸附系统治疗肝衰竭患者发生血管迷走神经反应相关因素分析及其处理对策研究^*[J]. 实用肝脏病杂志, 2022, 25(6): 828-831.
[11]	孙静, 张伟伟, 马智勇, 代树本, 邓彦东. 经颈静脉肝内门体分流术联合胃冠状静脉栓塞术治疗乙型肝炎肝硬化并发食管胃静脉曲张患者效果分析^*[J]. 实用肝脏病杂志, 2022, 25(6): 853-856.
[12]	詹致远, 申洋, 王凡冰. 内镜下套扎术联合奥美拉唑和奥曲肽治疗肝硬化并发食管静脉曲张首次出血患者短期疗效分析^*[J]. 实用肝脏病杂志, 2022, 25(6): 865-868.
[13]	毛月琴, 张红侠, 宋海燕, 刘波, 董静, 陈照林, 杨小康, 周旭, 娄方明. TACE联合毒痰瘀脾虚方治疗原发性肝癌患者临床疗效研究[J]. 实用肝脏病杂志, 2022, 25(6): 873-876.
[14]	蓝思荣, 徐继威, 张耀明, 李雄, 沈登文, 苏鸿辉. 实时超声造影与3D超声融合成像导航评估微波消融治疗原发性肝癌患者价值研究^*[J]. 实用肝脏病杂志, 2022, 25(6): 889-892.
[15]	蒋彪, 付彤, 吴旭栋. 高强度聚焦超声联合人工液胸治疗不可切除小儿肝母细胞瘤短期疗效研究^*[J]. 实用肝脏病杂志, 2022, 25(6): 893-896.