非酒精性脂肪肝的治疗研究

Nonalcoholic Fatty Liver Disease Treatment Research

目的:观察二甲双胍联合吡格列酮对非酒精性脂肪肝(NAFLD)患者的治疗效果。方法:选取38例NAFLD患者,按1:2比例随机分为二甲双胍治疗组(A组,12例)和二甲双胍联合吡格列酮组(B组,26例),观察6个月。比较2组治疗前后肝酶学、腰围、血压、血脂、血糖、胰岛素以及HOMA胰岛素抵抗指标的变化。结果:治疗后2组转氨酶均下降,B组转氨酶复常率高于A组(75%对56%,P<0.05);体重指数(BMI)在A组从26.0±3.4降至3个月的24.8±3.3和6个月的24.3±3.1(P<0.05),B组从26.5±3.3至25.4±2.5和25.0±2.3(P<0.05);腰围在观察期间2组均下降(幅度2cm至4cm);6个月治疗后空腹、糖耐量试验2h(OGTT-2h)血糖/胰岛素和甘油三脂浓度均明显下降,下降幅度B组高于A组(P<0.05);代表胰岛素抵抗的指标HOMA-IR在2组均明显改善(P<0.05),B组改善更明显(P<0.05)。结论:对NAFLD患者予二甲双胍联合吡格列酮治疗,在改善肝酶学的异常和胰岛素抵抗方面疗效优于单用二甲双胍的治疗。

Objective： Insuhn resistance is implicated in the pathogenesis of nonalcoholic fatty liver disease （NAFLD）.This study was to investigate the effect of combined metformin with pioglitazone on liver enzyme abnormalities in patients with NAFLD. Methods： Thirsty-eight cases of NAFLD were divided into 2 groups, metformin treatment group （A group, n=12） and combined metformin with pioglitazone treatment group （B group, n=26）,observe for 6 months. The changes of liver enzyme tests, waist circumference, blood pressure, lipid profiles, plasma glucose, insulin and the HOMA insulin resistance index were analyzed in 2 groups. Results： ALT and AST declined in 2 groups after 3, 6 months＇ treatment; enzyme abnormalities were normalized among 56% and 75% patients in A and B group （P〈0.05）. Fasting and 2 hours plasma glucose, insulin level and fasting triglycerides decreased after treatment. The effect was more evident in B group than in A group .HOMA-IP, declined from （5.1 ± 0.6） to （3.0 ± 0.2） in B group（P〈 0.05） and from （5.0 ± 0.6） to （3.1 ± 0.4） in A group （P〈0.05） after 6 months＇ treatment, and it was lower in B group than in A group （P〈0.05）. Conclusions： Combination of metformin and pioglitazone therapy improves the abnormalities of liver enzyme tests in NAFLD. The efficacy is superior to simple metformin therapy.