他汀类降脂药联合胰岛素增敏剂对非酒精性脂肪肝的疗效及动脉弹性的影响

Effect of a combination of atorvastatin and metformin on non-alcoholic fatty liver and arterial elasticity

目的探讨他汀类降脂药联合胰岛素增敏剂对非酒精性脂肪肝(NAFLD)的疗效及动脉弹性的影响。方法将收集的238例NAFLD患者随机分成4组,阿托伐他汀组60例(立普妥,美国辉瑞公司,20 mg,1次/d);二甲双胍组55例(中美上海施贵宝制药有限公司,商品名格华止,0.25 mg,3次/d);阿托伐他汀联合二甲双胍58例(立普妥,20 mg,1次/d+格华止,0.25 mg,3次/d);安慰组65例(控制饮食及运动)。观察治疗前及治疗6个月后各组血清谷丙转氨酶(ALT)及谷草转氨酶(AST)、肝脏超声影像、血液总胆固醇(TC)、三酰甘油(TG)、低密度胆固醇(LDL-C)、体重指数(MBI)、脉搏波传导速度(PWV)。结果阿托伐他汀组、二甲双胍组、联合组及安慰组的脂肪肝疗效分别为66.7%、67.3%、82.8%和47.7%,联合组疗效明显优于单法治疗;联合治疗在降低血脂、肝功能恢复和动脉弹性指数逆转上明显优于单法治疗,各组无严重药物不良反应。结论阿托伐他汀联合胰岛素增敏剂二甲双胍对NAFLD疗效及动脉硬化逆转有明显疗效。

【Objective】 To investigate the combined effects of atorvastatin and metformin on non-alcoholic fatty liver and arterial elasticity. 【Methods】 A total of 238 patients with non-alcoholic fatty liver were randomly divided into atorvastatin group（n = 60, lipitor, 20 mg, qd）, metformin group（n = 55, glucophage, 0.25 mg, tid）, combination group（n = 58, lipitor, 20 mg, qd, plus glucophage, 0.25 mg, tid） and placebo group（n =65）. All the patients were treated by the strict diet and movement intervention. The changes of alanine aminotransferase（ALT）, aspartate aminotransferase（AST）, total cholesterol（TC）, low density cholesterol（LDL-C）,triglyceride（TG）, body-mass index（MBI）, the ultrasound imaging of liver and pulse wave velocity（PWV） were observed before and six months after treatment. 【Results】 The effect in the atorvastatin group, the metformin group, the combination group and the placebo group was 66.7%, 67.3%, 82.8% and 47.7%, respectively, the effect in the combination group was superior to other groups on lowering cholesterol, recovering liver function and reversion of the arterial stiffness. No severe adverse drug reaction occurred. 【Conclusion】 The combination of atorvastatin and metformin has significant effect on reversion of arterial stiffness.