二甲双胍对2型糖尿病合并非酒精性脂肪肝病患者血清nesfatin-1及肝脂肪变的影响

Effects of metformin on the serum nesfatin-1 and liver steatosis in type 2 diabetic patients with nonalcoholic fatty liver disease

目的探讨二甲双胍对2型糖尿病(DM)合并非酒精性脂肪肝病(NAFLD)患者血清nesfatin-1及肝脂肪变的影响。方法选取2型DM合并NAFLD患者60例,随机分为观察组和对照组各30例。对照组给予饮食及运动治疗;观察组在饮食及运动治疗基础上加用二甲双胍,疗程为12周。比较2组治疗前及治疗12周后体质量指数(BMI)、空腹血糖(FPG)、空腹胰岛素(FIN)、糖化血红蛋白(HbA_(1c))、TC、TG、LDL-C、HDL-C、胰岛素抵抗指数(HOMAIR)、nesfatin-1等指标变化。治疗前及治疗12周后,所有患者进行肝脏CT检查,评价肝脂肪变的程度。结果与治疗前比较,治疗12周后观察组BMI、FPG、HOMA-IR、HbA_(1c)、TG、TC、nesfatin-1均明显改善,差异有统计学意义(P<0.05);对照组BMI、FPG、HOMA-IR、HbA_(1c)、TG、TC略下降,FIN、nesfatin-1、HDL-C、LDL-C无明显改善,差异均无统计学意义(P>0.05);与对照组比较,观察组BMI、FPG、HOMA-IR、HbA_(1c)、TG、TC、nesfatin-1均改善明显,差异有统计学意义(P<0.05)。治疗12周后,观察组总有效率为71.43%,高于对照组的35.71%(P<0.05)。观察组肝脂肪变的程度与BMI、HOMA-IR、TG、TC呈正相关(r=0.396、0.369、0.347、0.428,P均<0.05),与nesfatin-1呈负相关(r=-7.37,P<0.05)。结论二甲双胍可以改善胰岛素抵抗、调节糖脂代谢紊乱、减少肝脏脂肪变程度。而nesfatin-1可调节胰岛素的分泌和肝糖合成,可能是二甲双胍调节糖脂代谢、改善肝脏胰岛素抵抗的作用位点之一,有望成为2型DM合并NAFLD治疗的新靶点。

Objective To investigate the effects of metformin on the serum nesfatin 1 and liver steatosis in type 2 dia-betic patients with nonalcoholic fatty liver disease .Methods Selected 60 cases of type 2 DM patients with NAFLD , they were randomly divided into observation group and control group with each group of 30 cases.The control group received diet and ex-ercise therapy;observation group therapy based on diet and exercise plus metformin treatment for 12 weeks.Before and 12 weeks after treatment, compared of the two groups＆#39;body mass index （BMI）, fasting plasma glucose （FPG）, fasting plasma insulin （FIN）, glycated serum protein （HbA1c）, TC, TG, LDL-C, HDL-C, insulin resistance index（HOMA-IR）,nesfatin-1 and other indicators of change .Before treatment and 12 weeks after treatment , all patients received liver CT examination , evaluate the degree of hepatic steatosis .Results Compared with before treatment , after 12 weeks of treatment , BMI, FPG, HOMA-IR, HbA1c , TG, TC, nesfatin-1 in the observation group were significantly improved , and the difference was statisti-cally significant （ P 〈0.05）;the control group BMI, FPG, HOMA-IR, HbA1c, TG, TC decreased slightly,FIN,nesfatin-1, HDL-C, LDL-C showed no significant improvement , there was no statistical difference significance （ P 〉0.05）.Compared with the control group , the observation group BMI , FPG, HOMA-IR, HbA1c , TG, TC, nesfatin-1 have improved significant-ly, and the difference was statistically significant （ P 〈0.05）.After 12 weeks of treatment, total effective rate was 71.43%, higher than the 35.71%in control group（ P 〈0.05）.Hepatic steatosis＆#39;s extent and BMI,HOMA-IR,TG,TC was positively correlated（ r =0.396,0.369,0.347,0.428, P 〈0.05）,and nesfatin-1 was negatively correlated （ r =-7.37, P 〈0.05）.＆amp;nbsp;Conclusion Metformin can improve insulin resistance , regulate glucose and lipid metabolism , reduce the degree of hepatic steatosis.The nesfatin-1 can regulate the secretion of insulin and glycogen synthesis , probably Metformin, one of the sites of action to improve hepatic insulin resistance , is expected to become a new target for the treatment of type 2 DM merger of NAFLD.