关键词: 非酒精性脂肪性肝炎, 2型糖尿病, 胰高血糖素样肽-1受体激动剂, 糖代谢, 脂代谢, 治疗

Abstract: Objective The purpose of this study was to investigate clinical efficacy of glucagon-like peptide-1 receptor agonist (GLP-1RA) in the treatment of patients with type 2 diabetes mellitus (T2DM) and concomitant non-alcoholic steatohepatitis (NASH). Methods 83 patients with T2DM and NASH were encountered in our hospital between May 2021 and December 2024, and were randomly assigned to receive metformin in 41 cases in control, or to receive semaglutide at base of metformin treatment in another 42 cases in observation for 24 weeks. Glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), 2-hour postprandial glucose (2hPG), triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) levels were routinely detected. Serum C-reactive protein (CRP), tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) levels were assayed by ELISA. Controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) were determined by Fibrotouch. Results By end of six-month treatment, FPG, 2hPG, HbA1c and insulin resistance index (HOMA-IR) in the observation group were (6.1±0.8)mmol/L, (7.6±1.7)mmol/L, (6.1±0.7)% and (3.5±0.7), all much lower than [(7.1±1.0)mmol/L, (9.2±1.9)mmol/L, (6.8±0.8)% and (4.6±0.9), respectively, P<0.05] in the control; CAP and LSM were (288.5±20.7)dB/m and (9.1±1.3)kPa, both significantly lower than [(324.6±26.8)dB/m and (11.5±1.5)kPa, respectively, P<0.05] in the control; serum TG, TC and LDL-C levels were (2.4±0.8)mmol/L, (4.6±0.8)mmol/L and (3.0±0.5)mmol/L, all much lower than [(2.9±0.7)mmol/L, (5.1±0.8)mmol/L and (3.4±0.5)mmol/L, respectively, P<0.05] in the control; serum TNF-α, IL-6 and CRP levels were (9.1±1.9)pg/mL, (6.3±1.3)pg/mL and (3.6±0.9)mg/L, all much lower than [(14.1±2.6)pg/mL, (10.2±1.8)pg/mL and (6.3±1.3)mg/L, respectively, P<0.05] in the control group. Conclusion GLP-1RA, semaglutide, in treatment of patients with T2DM and NASH could remarkably improve glucose and lipid metabolism, which might be due to inhibition of body inflammatory reactions.

Key words: Non-alcoholic steatohepatitis, Type 2 diabetes mellitus, Glucagon-like peptide-1 receptor agonist, Glucose metabolism, Lipid metabolism, Therapy