利格列汀联合门冬胰岛素50治疗肝源性糖尿病患者疗效及HOMA-IR和HOMA-β水平变化

doi:10.3969/j.issn.1672-5069.2021.02.023

摘要/Abstract

摘要： 目的观察应用利格列汀联合门冬胰岛素50治疗肝源性糖尿病患者的疗效及胰岛素抵抗指数(HOMA-IR)和胰岛β细胞功能指数(HOMA-β)水平的变化。方法 2017年1月~2019年12月我院收治的98例非酒精性脂肪性肝病合并肝源性糖尿病患者被随机分为对照组49例和观察组49例,分别给予门冬胰岛素50或门冬胰岛素50联合利格列汀治疗,两组均治疗观察12 w。使用血糖仪检测空腹血糖(FBG)和餐后2 h血糖(2 h PG)水平,采用胶体金法检测血清糖化血红蛋白(HbAlc)水平,并计算HOMA-IR和HOMA-β,使用全自动生化分析仪检测血清肝功能指标。结果在治疗后,观察组FPG水平为(6.3±3.9)mmol/L,显著低于对照组【(7.8±1.2)mmol/L,P<0.05】,2 h PG水平为(8.4±2.6)mmol/L,显著低于对照组【(11.5±2.8)mmol/L,P<0.05】,和HbAlc水平为(7.1±1.6)%,显著低于对照组【(8.3±1.9)%,P<0.05】;治疗后,观察组HOMA-IR为(1.5±0.2),显著低于对照组【(2.4±03),P<0.05】,而HOMA-β水平为(42.9±8.7),显著高于对照组【(33.5±7.2),P<0.05】;观察组血清谷丙转氨酶(ALT)水平为(53.9±13.7)U/L,显著低于对照组【(72.2±19.6)U/L,P<0.05】,谷草转氨酶(AST)水平为(22.1±6.3)U/L,显著低于对照组【(46.4±6.9)U/L,P<0.05】,两组谷氨酰转肽酶、总胆红素和白蛋白水平无显著变化(P>0.05)。结论应用利格列汀联合门冬胰岛素50治疗非酒精性脂肪性肝病合并肝源性糖尿病患者能显著改善血糖水平,有效降低HOMA-IR,升高HOMA-β,改善了胰岛β细胞功能,从而改善患者的肝功能,具有良好的治疗效果。

关键词: 非酒精性脂肪性肝病, 肝源性糖尿病, 利格列汀, 门冬胰岛素50, 胰岛β细胞功能指数, 治疗

Abstract: Objective The aim of this study was to analyze the short-term efficacy of glicladine and insulin aspart 50 in the treatment of patients with non-alcoholic fatty liver diseases (NAFLD) and hepatogenic diabetes and to monitor the changes of homeostasis model assessment for insulin resistance (HOMA-IR) and index of β-cell function in homeostasis model assessment (HOMA-β).Methods 98 patients with NAFLD and hepatogenic diabetes were admitted to our hospital between January 2017 and December 2019 were randomly divided into control group (n=49) and observation group (n=49). The patients in the control group were treated with insulin aspart 50, while those in the observation group were treated with glicladine at the basis of insulin aspart 50. The regimen in both groups lasted for 12 weeks. The fasting blood glucose (FBG) , postprandial 2 hour blood glucose (2 h PG) and serum hemoglobin A1c (HbAlc) level were detected, and the HOMA-IR and HOMA-β were calculated. Serum liver function indexes were detected by automatic biochemical analyzer.Results At the end of 12 week treatment, the FPG level in observation group was (6.3±3.9) mmol/l, significantly lower than [ (7.8 ±1.2) mmol/l, P<0.05] in the control, the 2 h PG level was (8.4±2.6) mmol/l, significantly lower than [(11.5±2.8) mmol/l, P<0.05] in the control, and the HbAlc level was (7.1±1.6)%, significantly lower than [(8.3±1.9)%, P<0.05] in the control; the HOMA-IR in the observation group was (1.5±0.2) , significantly lower than [(2.4±03), P<0.05] in the control, while the HOMA-β was (42.9±8.7), significantly higher than [(33.5±7.2), P<0.05] in the control; serum alanine aminotransferase (ALT) level in the observation group was (53.9±13.7) U/L, significantly lower than [(72.2±19.6) U/L, P<0.05] in the control, and serum aspartate aminotransferase (AST) level was (22.1±6.3) U/L, significantly lower than [(46.4±6.9) U/L, P<0.05] in the control; Serum albumin, total bilirubin and glutamyl transpeptidase levels in the two groups were not significantly different before and after treatment (P>0.05).Conclusion The administration of glicladine and insulin aspart 50 in the treatment of patients with NAFLD and hepatogenic diabetes could significantly improve the blood sugar level recovery, which might related to the improvement of islet β cell functions and reduction of HOMA-IR.

Key words: Non-alcoholic fatty liver diseases, Hepatogenic diabetes, Glicladine, Insulin aspart 50, Homeostasis model assessment for insulin resistance, Index of β-cell function in homeostasis model assessment, Therapy

张彦, 夏文芳, 金进, 王黎. 利格列汀联合门冬胰岛素50治疗肝源性糖尿病患者疗效及HOMA-IR和HOMA-β水平变化[J]. 实用肝脏病杂志, 2021, 24(2): 240-243.

Zhang Yan, Xia Wenfang, Jin Jin, et al. Short-term observation ofglicladine and insulin aspart 50 in the treatment of patients with non-alcoholic fatty liver diseases and hepatogenic diabetes[J]. Journal of Practical Hepatology, 2021, 24(2): 240-243.

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