司美格鲁肽治疗2型糖尿病合并非酒精性脂肪性肝炎患者临床初步研究

doi:10.3969/j.issn.1672-5069.2025.05.015

摘要/Abstract

摘要： 目的观察应用司美格鲁肽联合二甲双胍治疗2型糖尿病(T2DM)合并非酒精性脂肪性肝炎(NASH)患者的临床疗效。方法 2022年10月～2023年10月我院诊治的T2DM合并NASH患者80例,被随机分为对照组和观察组,每组40例,分别给予盐酸二甲双胍缓释片或在此基础上给予司美格鲁肽皮下注射治疗24周。治疗前后行肝穿刺活检和使用FibroScan-502瞬时弹性成像仪行肝硬度检测(LSM)和检测受控衰减参数(CAP)。结果在治疗24 w末,观察组BMI、空腹血糖、餐后血糖、糖化血红蛋白和HOMA-IR分别为(23.9±0.7)kg/m²、(5.5±0.5)mmol/L、(6.5±1.2)mmol/ L、(6.3±0.7)%和(3.6±0.5),均显著低于对照组【分别为(25.6±0.8)kg/m²、(6.0±0.7)mmol/L、(7.9±1.0)mmol/L、(7.5±0.8)%和(4.7±0.7),P<0.05】;观察组血清TG、TC和LDL-C水平分别为(2.7±0.7)mmol/L、(5.1±1.0)mmol/L和(3.3±0.5)mmol/L,均显著低于对照组【分别为(3.4±0.8)mmol/L、(5.8±1.1)mmol/L和(3.7±0.6)mmol/L,P<0.05】,而血清HDL-C水平为(1.3±0.2)mmol/L,显著高于对照组【(1.1±0.2)mmol/L,P<0.05】;观察组肝功能指标改善优于对照组(P<0.05);观察组LSM和CAP分别为(8.6±1.0)kPa和(251.0±18.5)db/m,均显著低于对照组【分别为(10.1±0.9)kPa和(273.0±19.1)db/m,P<0.05】;治疗后,肝组织学检查显示观察组NASH活动度评分(NAS) 改善率为72.5%,显著高于对照组的25.0%。结论应用司美格鲁肽联合二甲双胍治疗T2DM合并NASH患者能改善血糖、血脂和肝功能,具有较好的短期疗效。

关键词: 非酒精性脂肪性肝炎, 2型糖尿病, 司美格鲁肽, 二甲双胍, 治疗

Abstract: Objective The aim of this study was to investigate clinical efficacy of semaglutide and metformin combination in treatment of patients with type 2 diabetes mellitus (T2DM) and concomitant nonalcoholic steatohepatitis (NASH). Methods Eighty patients with T2DM and NASH were encountered in our hospital between October 2022 and October 2023, and were randomly assigned to receive metformin in control or to receive metformin with combination of semaglutide subcutaneously in observation group for 24 weeks. Liver biopsies at presentation and at end of 24 week treatment were performed, and liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) were detected by Fibroscan 502. Results By end of 24-week treatment, body mass index (BMI), fasting blood glucose (FPG), 2-hour postprandial blood glucose (2hPG), hemoglobin A1c (HbAlc) and insulin resistance index (HOMA-IR)) in observation group were (23.9±0.7)kg/m², (5.5±0.5)mmol/L, (6.5±1.2)mmol/ L, (6.3±0.7)% and (3.6±0.5), all significantly lower than [(25.6±0.8)kg/m², (6.0±0.7)mmol/L, (7.9±1.0)mmol/L, (7.5±0.8)% and (4.7±0.7), respectively P<0.05] in the control; serum triglycerides (TG), total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) levels were(2.7±0.7)mmol/L,(5.1±1.0)mmol/L and (3.3±0.5)mmol/L, all much lower than [(3.4±0.8)mmol/L, (5.8±1.1)mmol/L and (3.7±0.6)mmol/L, respectively, P<0.05], while serum high-density lipoprotein cholesterol (HDL-C)) level was (1.3±0.2)mmol/L, much higher than [(1.1±0.2)mmol/L, P<0.05] in the control; serum liver function tests in the observation group improved greatly (P<0.05); LSM and CAP were (8.6±1.0)kPa and (251.0±18.5)db/m, both much lower than [(10.1±0.9)kPa and (273.0±19.1)db/m, respectively, P<0.05] in the control; liver histo-pathological examination showed that NASH activity score (NAS) improved in 72.5%, much higher than 25.0% in the control group. Conclusion The combination of semaglutide and metformin in treatment of patients with T2DM and NASH is efficacious short-termly, which might modulate blood sugar and lipid metabolism, and improve liver function tests.

Key words: Non-alcoholic steatohepatitis, Type 2 diabetes mellitus, Semaglutide, Metformin, Therapy

张磊, 王亚茹, 李会平, 王帅, 张威, 周正, 张帆. 司美格鲁肽治疗2型糖尿病合并非酒精性脂肪性肝炎患者临床初步研究[J]. 实用肝脏病杂志, 2025, 28(5): 699-702.

Zhang Lei, Wang Yaru, Li Huiping, et al. Clinical observation of semaglutide and metformin combination in treatment of patients with type 2 diabetes mellitus and concomitant nonalcoholic steatohepatitis[J]. Journal of Practical Hepatology, 2025, 28(5): 699-702.

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