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