DPP-4抑制剂对糖尿病合并脂肪肝患者FGF21水平的影响

Effect of DPP-4 inhibitor on serum FGF21 level in newly diagnosed type 2 diabetes mellitus patients with non-alcoholic fatty liver disease

目的探讨DPP-4抑制剂对初发2型糖尿病(T2DM)合并非酒精性脂肪肝(NAFLD)患者血清FGF21水平的影响。方法选取初发T2DM合并NAFLD患者76例,口服沙格列汀片,剂量5mg/次,1次/d,连续16周,分别于治疗前、治疗8周、16周时,检测血糖、血脂和肝功能,检测血清中FGF21水平,分别于治疗前和治疗16周时,检测肝脏脂肪含量。结果治疗8周和16周时患者血清FBG、2hPG、HbAlc、TC、TG、LDL-C、AST、ALT、GGT和FGF21水平均降低(P<0.05),而FINS和HDL-C水平升高(P<0.05),治疗16周时患者血清FBG、2hPG、HbAlc、TC、TG、LDL-C、AST、ALT、GGT和FGF21水平均低于治疗8周时(P<0.05);治疗前患者肝脏脂肪含量(16.1±7.6)%,治疗16周时患者肝脏脂肪含量(12.3±6.4)%(t=3.490,P=0.001);血清FGF21水平与FBG、2hPG、HbAlc、TG、LDL-C、AST、ALT、GGT水平、肝脏脂肪含量均呈正相关(P<0.05),而与FINS呈负相关(P<0.05);2hPG、TC、LDL-C和GGT是血清FGF21水平的独立影响因素(P<0.05)。结论 DPP-4抑制剂可减轻T2DM合并NAFLD患者体重,改善糖脂代谢,降低FGF21水平,从而减轻脂肪肝损伤,改善患者病情。

Objective To investigate the effect of DPP -4 inhibitor on serum FGF21 level in newly diagnosed type 2 diabetes mellitus （T2DM） patients with non - alcoholic fatty liver disease （NAFLD）. Methods 76 cases of newly diagnosed T2DM patients with NAFLD were selected. All patients were treated with saxagliptin, 5mg/time, 1 time/d, continuous for 16 weeks. Respectively, before treatment, after treatment 8 weeks and 16 weeks, the blood glucose, blood lipids and liver function were tested, the serum level of FGF21 was detected. Respectively, before treatment and after treatment 16 weeks, the liver fat content was detected. Results The serum levels of FBG, 2hPG, HbAlc, TC, TG, LDL- C, AST, ALT, GGT and FGF21 after treatment 8 weeks and 16 weeks were decreased （P 〈 0.05）, while the levels of FINS and HDL - C were increased （P 〈 0.05 ）, The serum levels of FBG, 2hPG, HbAlc, TC, TG, LDL- C, AST, ALT, GGT and FGF21 after treatment 15 weeks were lower than the after treatment 8 weeks （P 〈0.05）. The liver fat content before treatment was （ 16.1± 7.6） %, and after treatment 16 weeks was （ 12.3 ± 6.4） % （ t = 3. 490, P = 0. 001 ）. The serum level of FGF21 was positively correlated with the levels of FBG, 2hPG, HbAlc, TG, LDL- C, AST, ALT, GGT and the liver fat content （ P 〈 0. 05 ）, while was negatively correlated with FINS （ P 〈 0.05 ）. The 2hPG, TC, LDL - C and GGT were independent influencing factors for serum level of FGF21 （ P 〈 0.05 ）. Conclusion DPP - 4 inhibitors could reduce the body weight of T2DM patients with NAFLD, improve glucose and lipid metabolism, reduce the level of FGF21, thereby reducing fatty liver injury and improve the patient＇s condition.