艾塞那肽在中青年2型糖尿病合并非酒精性脂肪肝治疗中的作用及对患者各项指标的影响

Effects on Various Indicators of Exenatide in Young and Middle-aged Patients with Type 2 Diabetes and Non-alcoholic Fatty Liver Disease

目的:观察艾塞那肽在中青年2型糖尿病合并非酒精性脂肪肝治疗中的作用,及对患者体质量、血糖、血脂、胰岛素抵抗及脂肪肝病变程度的影响。方法:口服降糖药治疗不达标的中青年2型糖尿病合并非酒精性脂肪肝患者70例随机分为两组,每组35例。观察组在原降糖方案基础上加用艾塞那肽,对照组在原方案基础上加用精蛋白生物合成人胰岛素注射液,干预时间3个月。比较患者治疗前后的体质量、体质指数(BMI)、腰围、胰岛素抵抗指数(HOMA-IR)、空腹血糖(FPG)、餐后2 h血糖(2h PG)、糖化血红蛋白(Hb A1c)、血脂(TG、TC、LDL-C、HDL-C)、肝功能指标(ALT、AST、GGT),及脂肪肝治疗疗效。结果:治疗3个月后,观察组的血糖控制与对照组无显著差异(P>0.05)。但观察组患者的体质量、BMI、腰围、HOMA-IR、TG、ALT、AST、GGT均较治疗前显著下降(P<0.05),且显著优于对照组(P<0.05);而对照组上述指标治疗前后差异无统计学意义(P>0.05)。观察组治疗脂肪肝的总有效率显著高于对照组(P<0.05)。结论:艾塞那肽在有效降糖的基础上,可明显减低体质量、降低TG、改善胰岛素抵抗,同时能降低肝酶并显著改善脂肪肝,有望成为中青年2型糖尿病合并非酒精性脂肪肝患者治疗的新选择。

Objective： To investigate the effect of exenatide on body weight,blood glucose,blood lipids,insulin resistance and the degree of fatty liver in young and middle-aged patients with type 2 diabetes and non-alcoholic fatty liver disease（ NAFLD）. Methods： Totally 70 young and middle-aged patients with poorly controlled type 2 diabetes and NAFLD were chosen and randomly divided into observation group and the control group with 35 cases in each group. The patients were treated with exenatide or isophane protamine biosynthetic human insulin injection for 3 months on the basis of original oral hypoglycemic drugs. The body weight,BMI,waist circumference,HOMA-IR,plasma glucose（ FPG）,2 hour postprandial blood glucose（ 2 h PG）,glycated hemoglobin（ Hb Alc）,blood lipids,liver function indices（ ALT,AST and GGT）,and the severity of fatty liver were compared before and after the treatment. Results： After the 3-month treatment,there was no significant difference in glycemic control between observation group and the control group. After treatment,the body weight,BMI,waist circumference,HOMA-IR,TG,ALT,AST and GGT in observation were significantly decreased than those before the treatment（ P〈0. 05）,and were superion to those in control group（ P〈0. 05）. While in the control group,all the above indices were not significantly changed before and after the treatment（ P〉0. 05）. The total efficiency for treating NAFLD in observation group was significantly higher than that in the control group（ P 〈 0. 05）. Conclusion： Besides reducing blood glucose effectively,exenatide can also obviously reduce body weight and TG level,improve insulin resistance,decrease liver enzymes,and significantly ameliorate the degree of fatty liver. The results suggested that exenatide might be a new therapeutic option for young and middle-aged patients with type 2 diabetes and NAFLD.