胰岛素与胰岛素促泌剂对2型糖尿病合并非酒精性脂肪肝的影响

Influence of insulin and insulin secretagogues on type 2 diabetes mellitus combined with nonalcoholic fatty liver disease

目的探讨胰岛素与胰岛素促泌剂对2型糖尿病合并非酒精性脂肪肝的影响。方法选取2014年1月-2015年2月延安大学附属医院东关分院综合内科收治的2型糖尿病合并非酒精性脂肪肝患者300例作为研究对象,依据治疗方案的不同将其分为胰岛素治疗组（皮下注射胰岛素治疗）和胰岛素促泌剂治疗组（格列齐特治疗）,每组150例。观察两组治疗前后糖代谢、脂代谢、胰岛素情况和治疗后脂肪肝分级情况。结果两组治疗前空腹血糖（FBG）、餐后2 h血糖（2h PBG）、糖化血红蛋白（Hb A1c）、总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）、空腹胰岛素（FINS）、稳态胰岛素评价指数（HOMA-IR）比较差异无统计学意义（P〉0.05）。治疗后两组FBG、2h PBG、Hb A1c、TC、TG、LDL、FINS、HOMA-IR均低于治疗前,HDL均高于治疗前,差异均有统计学意义（P〈0.05）,治疗后两组各检测指标和脂肪肝分级比较差异均无统计学意义（P〉0.05）。结论胰岛素与胰岛素促泌剂治疗2型糖尿病除能够改善患者血糖、血脂、胰岛素水平外,对非酒精性脂肪肝也有一定的改善作用,值得临床推广应用。

Objective To investigate the influence of insulin and insulin secretagogues on type 2 diabetes mellitus combined with nonalcoholic fatty liver disease. Methods Three hundred cases of patients with type 2 diabetes mellitus nonalcoholic fatty liver disease admitted to Department of General Medicine in Dongguan Branch of Yan＇an University Affiliated Hospital from January 2014 to February 2015 were selected as research objects, and they were divided into Insulin treatment group（subcutaneous injection of insulin） and insulin secretagogues treatment group（Gliclazide） according to different treating methods, with 150 cases in each group. The conditions of glycometabolism, lipid metabolism, insulin before and after treatment and the fatty liver disease classification after treatment in the two groups were observed. Results The levels of fasting blood glucose（FBG）, 2 h postprandial blood glucose（2h PBG）, hemoglobin A1c（Hb A1c）, total cholesterol（TC）, triglycerides（TG）, high density lipoprotein cholesterol（HDL）, low density lipoprotein cholesterol（LDL）, fasting insulin（FINS）, Homeostasis model assessment for insulin resistance（HOMA-IR） of the two groups before treatment had no significant differences（P〉0.05）. The levels of FBG, 2h PBG, Hb A1 c, TC, TG, LDL,FINS, HOMA-IR of two groups after treatment were lower than those before treatment, while HDL was higher than that before treatment, the differences were statistically significant（P〈0.05）. These indicators and fatty liver disease classification of the two groups after treatment had no significant difference（P〉0.05）. Conclusion The treatment of insulin and insulin secretagogues in the treatment of type 2 diabetes mellitus can improve patients＇ glycometabolism, lipid metabolism, insulin levels, which has a certain improving effect on nonalcoholic fatty liver disease, it is worthy of clinical promotion and application.