司美格鲁肽治疗2型糖尿病合并非酒精性脂肪性肝病患者疗效初步临床研究*

doi:10.3969/j.issn.1672-5069.2026.02.012

摘要/Abstract

摘要： 目的探讨应用司美格鲁肽治疗2型糖尿病(T2DM)合并非酒精性脂肪性肝病(NAFLD)患者的疗效。方法 2022年6月～2024年6月我院收治的104例T2DM合并NAFLD患者,被随机分为对照组52例和观察组52例,分别给予达格列净/二甲双胍口服或在此基础上给予司美格鲁肽逐级增量皮下注射24 w。使用全自动生化分析仪检测血生化指标,使用血糖仪检测血糖指标,使用瞬时弹性成像仪行肝脏硬度检测(LSM)和受控衰减参数(CAP),根据文献公式计算内脏脂肪指数(VAI)和脂质蓄积指数(LAP)。结果在治疗24周末,观察组血清ALT、AST水平和CAP值分别为(34.9±3.7)U/L、(35.8±3.6)U/L和(270.7±30.6)dB/m,均显著低于对照组【分别为(59.1±3.3)U/L、(51.1±3.9)U/L和(289.7±20.5)dB/m,P＜0.05】;观察组空腹血糖、餐后2 h血糖和糖化血红蛋白水平分别为(6.1±0.5)mmol/L、(7.5±0.9)mmol/L和(6.2±0.7)%,均显著低于对照组【分别为(6.6±0.6)mmol/L、(9.9±0.6)mmol/L和(7.1±0.6)%,P＜0.05】;观察组血清总胆固醇、甘油三酯、低密度脂蛋白胆固醇、内脏脂肪指数和脂质蓄积指数分别为(5.3±0.4)mmol/L、(2.1±0.2)mmol/L、(2.7±0.4)mmol/L、(103.7±9.2)和(55.9±6.9),均显著低于对照组【分别为(5.9±0.5)mmol/L、(2.7±0.3)mmol/L、(3.5±0.6)mmol/L、(119.2±10.3)和(61.4±7.2),P＜0.05】,而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【(1.0±0.2)mmol/L,P＜0.05】。结论应用司美格鲁肽联合达格列汀/二甲双胍治疗T2DM合并NAFLD患者短期疗效确切,可促进肝功能指标恢复,可能与参与了糖脂代谢调节有关。

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

Abstract: Objective The aim of this study was to investigate the efficacy of semaglutide in the treatment of patients with type 2 diabetes mellitus (T2DM) and non-alcoholic fatty liver disease (NAFLD). Methods 104 patients with T2DM and NAFLD were encountered in our hospital between June 2022 and June 2024, and were randomly assigned to receive oral dapagliflozin and metformin in 52 cases in the control, or subcutaneous injection of semaglutide at base of oral dapagliflozin and metformin in another 52 cases in the observation group for 24 weeks. Blood biochemical parameters and blood glucose index, including glycosylated hemoglobin (HbA1c) were routinely detected, and liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) were measured by transient elastography. The visceral adiposity index (VAI) and lipid accumulation product index (LAP) were calculated. Results By end of 24-week treatment, serum alanine aminotransferase, aspartate aminotransferase and CAP in the observation group were (34.9±3.7)U/L, (35.8±3.6)U/L and (270.7±30.6)dB/m, all significantly lower than [(59.1±3.3)U/L, (51.1±3.9)U/L and (289.7±20.5)dB/m, respectively, P＜0.05] in the control; fasting blood glucose, postprandial 2 h blood glucose and HbA1c were(6.1±0.5)mmol/L, (7.5±0.9)mmol/L and (6.2±0.7)%, all much lower than [(6.6±0.6)mmol/L, (9.9±0.6)mmol/L and (7.1±0.6)%, respectively, P＜0.05] in the control group; total cholesterol, triacylglycerol, low density lipoprotein cholesterol, VAI and LAP were(5.3±0.4)mmol/L, (2.1±0.2)mmol/L, (2.7±0.4)mmol/L, (103.7±9.2) and (55.9±6.9), all much lower than [(5.9±0.5)mmol/L, (2.7±0.3)mmol/L, (3.5±0.6)mmol/L, (119.2±10.3) and (61.4±7.2), respectively, P＜0.05], while high density lipoprotein cholesterol level was (1.3±0.3)mmol/L, much higher than [(1.0±0.2)mmol/L, P＜0.05] in the control group. Conclusion The clinical efficacy of semaglutide in the treatment of patients with T2DM and NAFLD at base of dapagliflozin and metformin is short-termly satisfactory, which might be related to modulation of glucose-lipid metabolism.

Key words: Non-alcoholic fatty liver disease, Type 2 diabetes mellitus, Semaglutide, Dapagliflozin, Metformin, Therapy

孙燕军, 许丽萍, 周凌, 朱金凤. 司美格鲁肽治疗2型糖尿病合并非酒精性脂肪性肝病患者疗效初步临床研究^*[J]. 实用肝脏病杂志, 2026, 29(2): 209-212.

Sun Yanjun, Xu Liping, Zhou Ling, et al. A preliminary study on the efficacy of semaglutide in the treatment of patients with type 2 diabetes mellitus and non-alcoholic fatty liver disease[J]. Journal of Practical Hepatology, 2026, 29(2): 209-212.

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司美格鲁肽治疗2型糖尿病合并非酒精性脂肪性肝病患者疗效初步临床研究^*

A preliminary study on the efficacy of semaglutide in the treatment of patients with type 2 diabetes mellitus and non-alcoholic fatty liver disease

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