罗格列酮及二甲双胍治疗非酒精性脂肪肝病的疗效观察

Therapeutic Effectiveness of Rosiglitazone or Metformin in the Treatment of Nonalcoholic Fatty Liver Disease

目的观察胰岛素增敏剂罗格列酮及二甲双胍对非酒精性脂肪肝病(NAFLD)的治疗效果。方法128例NAFLD患者,分为4组:A组为对照组,仅控制饮食和适度运动;B组应用罗格列酮治疗;C组应用二甲双胍治疗;D组应用罗格列酮合并二甲双胍治疗。治疗6个月后,分别检测各组患者治疗前后的体重(W)、腰臀比(WHR)、体重指数(BMI)、空腹血糖(FPG)、空腹血胰岛素(FINS)、血总胆固醇(TC)、血甘油三酯(TG)、谷草转氨酶(AST)、谷丙转氨酶(ALT)、γ-谷氨酰转移酶(GGT)及胰岛素抵抗指数HOMA-IR。根据症状、体征、肝脏B超和CT表现及各项生化检查结果综合判断各组患者的治疗效果。结果所有药物治疗组患者的TC、TG、AST、ALT、GGT、HOMA-IR均较治疗前明显改善,差异有显著性意义。药物治疗组的总有效率与对照组比较差异有极显著性意义(P<0.01)。罗格列酮治疗组与二甲双胍治疗组疗效相近,合并应用二者的疗效显著优于单独应用罗格列酮或二甲双胍治疗的效果。结论罗格列酮和二甲双胍治疗NAFLD安全有效,且2种药物合并治疗的效果要优于单药治疗。

Objective To observe the therapeutic effectiveness of rosiglitazone or metformin in the treatment of nonalcoholic fatty liver disease （NAFLD）. Methods One hundred and twenty-eight patients with NAFLD were divided into groups A, B, C and D. The patients in group A as a control only received a treatment with diet control and appropriate exercise. The patients in groups B and C were treated with rosiglitazone or metformin respectively. A combination therapy of rosiglitazone and metformin was performed in group D. After treatment for 6 months, some parameters such as body weight （W）, waist-to-hip ratio （WHR）, body mass index （BMI）, fasting plasma glucose （FPG）, fasting serum insulin （FINS）, total cholesterol （TC）, triglyeride （TG）, aspartate aminotransferase （AST）, alanine transaminase （ALT）, γ-glutamyltransferase （GGT） and insulin resistance index HOMA-IR before and after treatment were assayed. The therapeutic effectiveness in each group was analyzed by synthetic judgment according to symptoms, physical signs, B-ultrasonic examination and CT scanning in liver, and biochemical laboratory results. Results The TC, TG, AST, ALT, GGT and HOMA-IR in all medication groups were obviously improved as compared with those before treatment （P〈0.05）. Total effective rate in the medication groups was significantly higher than in control group （P〈0.01）. The therapeutic effectiveness was more satisfactory in group D than in group B and group C. Conclusion The treatment of NAFLD with rosiglitazone or metformin is safe and effective. The therapeutic effectiveness with combined treatment is superior to that with rosiglitazone or metformin alone.