吡格列酮对2型糖尿病合并非酒精性脂肪肝患者血浆同型半胱氨酸及胰岛素抵抗影响探讨

Discussion of the effects of pioglitazone on plasma homocysteine and insulin resistance in type 2 diabetes patients with nonalcoholic fatty liver

目的观察吡格列酮对2型糖尿病合并非酒精性脂肪肝患者血浆同型半胱氨酸(Hcy)水平及胰岛素抵抗的影响,为临床用药提供参考。方法依照随机数字表法将120例2型糖尿病合并非酒精性脂肪肝患者分为2组,治疗组60例给予吡格列酮15 mg/d口服;对照组60例给予二甲双胍缓释片1 g/d口服,治疗6个月后对比分析2组Hcy水平和胰岛素抵抗指数(HOMA-IR)。结果治疗后治疗组Hcy水平显著低于治疗前(P<0.05),对照组治疗前后Hcy水平无显著性差异;治疗后2组患者HOMA-IR均较治疗前下降(P均<0.05),但是观察组优于对照组(P<0.05)。结论吡格列酮可以有效降低2型糖尿病合并非酒精性脂肪肝患者的Hcy水平,并显著改善患者的HOMA-IR,且基本不会对患者肾功能造成伤害,值得临床推广应用。

Objective It is to observe the effect of pioglitazone on plasma homocysteine （Hcy） and insulin resistance in type 2 diabetes patients with nonalcoholic fatty liver, and to provide evidences for the treatment in clinic. Methods According to the random number table 120 patients with type 2 diabetes complicating with nonalcoholic fatty liver were divided into two groups, the treatment group （n = 60） was given pioglitazone, 15 mg/d; the control group （n = 60） was given metformin tablets, 1 g/d. After six months＇ treatment, The level of Hey and insulin resistance index .（ HOMA - IR） were analyzed and compared in both groups. Results After treatment, the Hey level were significantly lower than before treatment in treatment group （P 〈 0.05）, but that in the control group had no significant change before and after treatment. After treatment, HOMA -IR decreased obviously（ P 〈 0.05 ） , but the decrease in the treatment group was more than that in the control group （P 〈 0.05 ）. Conclusion Pioglitazone can effectively reduce the level of Hey in type 2 diabetes mellitus patients with non-alcoholic fatty liver, and significantly improve patient＇s HOMA -IR, without little renal function damage, so it is worthy using in clinic.