司美格鲁肽联合化痰祛瘀通络方治疗NAFLD合并T2DM患者临床疗效初步研究*

doi:10.3969/j.issn.1672-5069.2025.06.012

摘要/Abstract

摘要： 目的探讨应用司美格鲁肽联合化痰祛瘀通络方治疗非酒精性脂肪性肝病(NAFLD)合并2型糖尿病(T2DM)患者临床疗效及其血清高迁移率族蛋白1(HMGB1)和脂联素(APN)的变化。方法 2022年1月～2024年12月我院收治的NAFLD合并T2DM患者120例,被随机分为单药组(n=60)和联合组(n=60),分别给予司美格鲁肽或在该药治疗的基础上给予化痰祛瘀通络方治疗12周。采用ELISA法检测血清HMGB1和APN水平。结果在治疗12周末,联合组血清谷氨酰转肽酶(GGT)水平为(62.4±9.2)U/L,显著低于单药组【(84.2±12.3)U/L,P<0.05】;血清Ⅳ型胶原(Ⅳ-C)、透明质酸(HA)和Ⅲ型前胶原(PCⅢ)水平分别为(49.8±0.9)ng/mL、(72.5±11.1)ng/mL和(6.5±0.8)ng/mL,均显著低于单药组【分别为(66.6±1.0)ng/mL、(87.4±13.7)ng/mL和(8.1±0.9)ng/mL,P<0.05】;胰岛素抵抗指数(HOMA-IR)为(2.5±0.4),显著低于单药组【(3.1±0.6),P<0.05】;血清三酰甘油(TG)、总胆固醇(TC)和低密度脂蛋白胆固醇(LDL-C)水平分别为(1.7±0.4)mmol/L、(4.3±1.0)mmol/L和(2.2±0.7)mmol/L,均显著低于单药组【分别为(2.4±0.5)mmol/L、(5.0±1.1)mmol/L和(2.9±0.8)mmol/L,P<0.05】,而血清高密度脂蛋白胆固醇(HDL-C)水平为(1.2±0.4)mmol/L,显著高于单药组【(1.0±0.3)mmol/L,P<0.05】;血清HMGB1水平为(6.4±1.9)ng/mL,显著低于单药组【(9.2±2.6)ng/mL,P<0.05】,而血清APN水平为(15.1±5.8)μg/mL,显著高于单药组【(11.9±5.4)μg/mL,P<0.05】。结论在应用司美格鲁肽治疗的基础上联合化痰祛瘀通络方治疗NAFLD合并T2DM患者可以有效改善胰岛素抵抗,纠正血脂代谢紊乱,可能与降低了血清HMGB1水平和升高了APN水平有关。

关键词: 非酒精性脂肪性肝病, 2型糖尿病, 司美格鲁肽, 化痰祛瘀通络方, 高迁移率族蛋白1, 脂联素, 治疗

Abstract: Objective The aim of this study was to investigate the clinical efficacy of semaglutide in combination with Huatan Quyu Tongluo, a herbal decoction in the treatment of patients with nonalcoholic fatty liver disease (NAFLD) and concomitant type 2 diabetes mellitus (T2DM) and its influence on serum high mobility group protein 1 (HMGB1) and adiponectin (APN) levels. Methods 120 patients with NAFLD and T2DM were enrolled in our hospital between January 2022 and December 2024, and were randomly assigned to receive subcutaneously semaglutide in control (n=60) or to receive Huatan Quyu Tongluo decoction at basis of semaglutide in combination group (n=60) for 12 weeks. Serum HMGB1 and APN levels were detected by ELISA kit. Results By end of 12-week treatment, serum glutamyltransferase level in combination group was(62.4±9.2)U/L, much lower than [(84.2±12.3)U/L, P<0.05] in the control; type IV collagen, hyaluronic acid and type Ⅲ procollagen were (49.8±0.9)ng/mL, (72.5±11.1)ng/mL and (6.5±0.8)ng/mL, all significantly lower than [(66.6±1.0)ng/mL, (87.4±13.7)ng/mL and (8.1±0.9)ng/mL, respectively, P<0.05] in the control; the homeostasis model assessment of insulin resistance was(2.5±0.4), much lower than [(3.1±0.6), P<0.05] in the control; serum triglyceride, total cholesterol and low-density lipoprotein cholesterol were(1.7±0.4)mmol/L, (4.3±1.0)mmol/L and (2.2±0.7)mmol/L, all much lower than [(2.4±0.5)mmol/L, (5.0±1.1)mmol/L and (2.9±0.8)mmol/L, respectively, P<0.05], while serum high-density lipoprotein cholesterol was (1.2±0.4)mmol/L, much higher than [(1.0±0.3)mmol/L, P<0.05] in the control; serum HMGB1 level was (6.4±1.9)ng/mL, much lower than [(9.2±2.6)ng/mL, P<0.05], while serum APN level was (15.1±5.8)μg/mL, much higher than [(11.9±5.4)μg/mL, P<0.05] in the control group. Conclusion Combination of semaglutide and Huatan Quyu Tongluo decoction could effectively alleviate insulin resistance and correct lipid metabolism disorders in patients with NAFLD and T2DM, which might be related to the inhibition of HMGB1 secretion and increased APN level.

Key words: Nonalcoholic fatty liver disease, Type 2 diabetes mellitus, Semaglutide, Huatan Quyu Tongluo decoction, High mobility group protein 1, Adiponectin, Therapy

陈晓玲, 张盼盼, 付玉芳, 王静. 司美格鲁肽联合化痰祛瘀通络方治疗NAFLD合并T2DM患者临床疗效初步研究^*[J]. 实用肝脏病杂志, 2025, 28(6): 846-849.

Chen Xiaoling, Zhang Panpan, Fu Yufang, et al. Clinical efficacy of semaglutidein combination with Huatan Quyu Tongluo decoction in the treatment of patients with NAFLD and T2DM: A pilot study[J]. Journal of Practical Hepatology, 2025, 28(6): 846-849.

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司美格鲁肽联合化痰祛瘀通络方治疗NAFLD合并T2DM患者临床疗效初步研究^*

Clinical efficacy of semaglutidein combination with Huatan Quyu Tongluo decoction in the treatment of patients with NAFLD and T2DM: A pilot study

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