罗格列酮联合二甲双胍治疗非酒精性脂肪性肝病合并T2DM患者临床疗效研究*

doi:10.3969/j.issn.1672-5069.2025.04.017

摘要/Abstract

摘要： 目的探讨应用罗格列酮联合二甲双胍治疗非酒精性脂肪性肝病(NAFLD)合并2型糖尿病(T2DM)患者的近期疗效。方法 2023年1月～2024年3月我院收治的NAFLD合并T2DM患者98例,被随机分为对照组49例和观察组49例,分别予以二甲双胍或罗格列酮联合二甲双胍治疗观察24 w。常规检测血生化指标,采用放射免疫法检测空腹胰岛素,使用Fibroscan肝瞬时弹性检测仪行肝脏硬度检测(LSM)和受控衰减参数(CAP)检测。结果在治疗24 w末,观察组血清高密度脂蛋白胆固醇水平为(1.3±0.3)mmol/L,显著高于对照组【(1.1±0.2)mmol/L,P＜0.05】,而血清甘油三酯水平为(2.0±0.3)mmol/L,显著低于对照组【(2.9±0.5)mmol/L,P＜0.05】;观察组空腹胰岛素水平为(6.5±1.3)μU/ml,显著低于对照组【(7.4±1.6)μU/ml,P＜0.05】,而两组糖化血红蛋白和空腹血糖水平无显著性相差(P>0.05);观察组血清AST水平和CAP分别为(38.9±4.3)U/L和(266.1±10.7)dB/m,均显著低于对照组【分别为(45.4±4.8)U/L和(286.0±11.9)dB/m,P＜0.05】。结论应用罗格列酮联合二甲双胍治疗NAFLD合并T2DM患者能在控制血糖水平的同时改善脂代谢紊乱,值得临床进一步研究。

关键词: 非酒精性脂肪性肝病, 2型糖尿病, 罗格列酮, 二甲双胍, 治疗

Abstract: Objective The aim of this study was to investigate clinical efficacy of rosiglitazone and metformin combination in the treatment of patients with non-alcoholic fatty liver disease (NAFLD)and type 2 diabetes mellitus(T2DM). Methods A total of 98 patients with NAFLD and T2DMwere enrolled in our hospital between January 2023 and March 2024, and were randomly assigned to receive oral metformin (control, n=49) or combination of metformin and rosiglitazone (observation, n=49) for six months. Serum high density lipoprotein cholesterol(HDL-C), total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), glycosylated hemoglobin (HbA1c) and fasting blood glucose (FBG) levels were routinely detected. Fasting insulin level was detected by radioimmunoassay. Liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) were detected by Fibroscan. Results By end of six-month treatment, serum HDL-C level in the observation group was(1.3±0.3)mmol/L, much higher than [(1.1±0.2)mmol/L, P＜0.05], while serum TG level was(2.0±0.3)mmol/L, much lower than [(2.9±0.5)mmol/L, P＜0.05] in the control; fasting insulin level in the observation was (6.5±1.3)μU/ml, much lower than [(7.4±1.6)μU/ml, P＜0.05] in the control, while there were no significant differences as respect to HbA1c and FBG between the two groups(P>0.05); serum AST and CAP were (38.9±4.3)U/L and (266.1±10.7)dB/m, both much lower than [(45.4±4.8)U/L and (286.0±11.9)dB/m, respectively, P＜0.05]in the control group. Conclusion Rosiglitazone and metformin combination in the treatment of patients with NAFLD and T2DM could improve lipid metabolism disorder, which is worthy of further clinical study.

Key words: Non-alcoholic fatty liver disease, Type 2 diabetes mellitus, Rosiglitazone, Metformin, Treatment

张淑玮, 张惠娟, 周杰. 罗格列酮联合二甲双胍治疗非酒精性脂肪性肝病合并T2DM患者临床疗效研究^*[J]. 实用肝脏病杂志, 2025, 28(4): 545-548.

Zhang Shuwei, Zhang Huijuan, Zhou Jie. Clinical observation of rosiglitazone and metformin combination in the treatment of patients with non-alcoholic fatty liver disease and type 2 diabetes mellitus[J]. Journal of Practical Hepatology, 2025, 28(4): 545-548.

参考文献

[1] Qi F, Li T, Deng Q,et al. The impact of aerobic and anaerobic exercise interventions on the management and outcomes of non-alcoholic fatty liver disease. Physiol Res, 2024, 73(5):671-686.
[2] Heo JH, Lee MY, Kim SH,et al. Comparative associations of non-alcoholic fatty liverdisease and metabolic dysfunction-associated steatotic liver disease with risk of incident chronic kidney disease: a cohort study. Hepatobiliary Surg Nutr, 2024, 13(5):801-813.
[3] Hiruma S, Shigiyama F, Kumashiro N. Empagliflozin versus sitagliptin for ameliorating intrahepatic lipid content and tissue-specific insulin sensitivity in patients with early-stage type 2 diabetes with non-alcoholic fatty liver disease: A prospective randomized study. Diabetes Obes Metab, 2023, 25(6):1576-1588.
[4] En Li Cho E, Ang CZ, Quek J, et al. Global prevalence of non-alcoholic fatty liver disease in type 2 diabetes mellitus: an updated systematic review and meta-analysis. Gut, 2023, 72(11):2138-2148.
[5] Labenz C, Kostev K, Alqahtani SA, et al. Impact of non-alcoholic fattyliver disease on metabolic comorbidities in type 2 diabetes mellitus. Exp Clin Endocrinol Diabetes, 2022, 130(3):172-177.
[6] 孙峥,王笑烨,袁景,等. 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. 实用肝脏病杂志,2022,25(6):796-799.
[7] Gkiourtzis N, Michou P, Moutafi M, et al. The benefit of metformin in the treatment of pediatric non-alcoholic fatty liver disease: a systematic review and meta-analysis of randomized controlled trials. Eur J Pediatr, 2023, 182(11):4795-4806.
[8] Abushamat LA, Schauer IE, Low Wang CC, et al. Rosiglitazone improves insulin resistance but does not improve exercise capacity in individuals with impaired glucose tolerance: a randomized clinical study. J Investig Med, 2024, 72(3):294-304.
[9] 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.
[10] 中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2020年版). 中华糖尿病杂志,2021,13(4):315-409.
[11] 朱燕, 胡竞成, 吴梦娇, 等. 血清CXC趋化因子配体17与2型糖尿病合并非酒精性脂肪性肝病的相关性研究. 中华糖尿病杂志, 2024, 16(2):214-219.
[12] 吕春卉, 李大炜, 王小洁, 等. 二甲双胍联合辛伐他汀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, 2022, 25(1):50-53.
[13] Castera L, Laouenan C, Vallet-Pichard A, et al. High prevalence ofNASH and advanced fibrosis in type 2 diabetes: a prospective study of 330 outpatients undergoing liver biopsies for elevated alt, using a low threshold. Diabetes Care, 2023, 46(7):1354-1362.
[14] Muhammad AG, Hansen FO, Gantzel RH,et al. Non-alcoholic fatty liver disease in patients with type 2 diabetes in Greenland: a register-based cross-sectional study. Int J Circumpolar Health, 2022, 81(1):2065755.
[15] Pinyopornpanish K, Leerapun A, Pinyopornpanish K, et al. Effects of metformin on hepatic steatosis in adults with nonalcoholic fatty Liver disease and diabetes: insights from the cellular to patient levels. Gut Liver, 2021, 15(6):827-840.
[16] Li XY, Ji PX, Ni XX, et al. Regulation of PPAR-γ activity in lipid-laden hepatocytes affects macrophage polarization and inflammation in nonalcoholic fatty liver disease. World J Hepatol, 2022, 14(7):1365-1381.
[17] Shi M, Zhang H, Wang W, et al. Effect of dapagliflozin on liver and pancreatic fat in patients with type 2 diabetes and non-alcoholic fatty liver disease. J Diabetes Complications, 2023, 37(10):108610.
[18] Frankowski R, Kobierecki M, Wittczak A, et al. Type 2 diabetes mellitus, non-alcoholic fatty liver disease, and metabolic repercussions: the vicious cycle and its interplay with inflammation. Int J Mol Sci, 2023, 24(11):9677.
[19] Koohi F, Ahmadi N, Azizi F, et al. Patterns of change in obesity indices and other cardiometabolic risk factors before the diagnosis of type 2 diabetes: two decades follow-up of the Tehran lipid and glucose study. J Transl Med, 2022, 20(1):518.
[20] Par A, Wittmann I, Par G. Non-alcoholic fatty liver disease and type 2 diabetes mellitus. Orv Hetil, 2022, 163(22):855-862.
[21] Loosen SH, Krieg S, Krieg A, et al. Non-alcoholic fatty liver disease is associated with an increased risk of type 2 diabetes. Eur J Gastroenterol Hepatol, 2023, 35(6):662-667.
[22] Marcondes-de-Castro IA, Reis-Barbosa PH, Marinho TS, et al. AMPK/mTOR pathway significance in healthy liver and non-alcoholic fatty liver disease and its progression. J Gastroenterol Hepatol, 2023, 38(11):1868-1876.
[23] Younossi ZM, Golabi P, Price JK, et al. The global epidemiology of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis among patients with type 2 diabetes. Clin Gastroenterol Hepatol, 2024, 22(10):1999-2010.
[24] Zhang X, Wong GL, Yip TC, et al. Risk of liver-related events by age and diabetes duration in patients with diabetes and nonalcoholic fatty liver disease. Hepatology, 2022, 76(5):1409-1422.
[25] O'Beirne J, Skoien R, Leggett BA, et al. Diabetes mellitus and the progression of non-alcoholic fatty liver disease to decompensated cirrhosis: a retrospective cohort study. Med J Aust, 2023, 219(8):358-365.

罗格列酮联合二甲双胍治疗非酒精性脂肪性肝病合并T2DM患者临床疗效研究^*

Clinical observation of rosiglitazone and metformin combination in the treatment of patients with non-alcoholic fatty liver disease and type 2 diabetes mellitus

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