磷酸西格列汀和格列美脲片治疗2型糖尿病合并非酒精性脂肪肝的效果比较

Comparison of the effects of sitagliptin phosphate and glimepiride tablets in the treatment of type 2 diabetes mellitus combined with nonalcoholic fatty liver disease

目的:对比磷酸西格列汀和格列美脲片治疗2型糖尿病(T2DM)合并非酒精性脂肪肝(NAFLD)的临床效果。方法:选取2014年1月至2017年1月攀钢集团总医院收治的60例T2DM合并NAFLD患者,按随机数字表法分为观察组和对照组,每组30例,两组均给予二甲双胍作为基础治疗,观察组加用磷酸西格列汀治疗,对照组加用格列美脲片治疗,比较两组治疗前、后糖化血红蛋白(HbAlc)、空腹血糖(FPG)、餐后2h血糖(2hPG)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TC)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、谷氨酰转肽酶(GGT)、胰岛素抵抗指数(HOMA-IR)、胰岛素敏感指数(HOMA-IS)、体重指数(Ibm)、脂肪肝疗效及不良反应发生率。结果:观察组脂肪肝治疗总有效率高于对照组(P<0.05);两组治疗后HbAlc、FPG、2hPG、TG、LDL-C、TC水平及Ibm均明显降低(P<0.05),但两组间比较,差异无统计学意义(P>0.05);观察组治疗后ALT、AST、GGT水平及HOMA-IR明显低于对照组(P<0.05),且HOMA-IS显著高于对照组(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:磷酸西格列汀治疗T2DM合并NAFLD,能更有效降低血糖、血脂水平及体重,提高肝功能和胰岛素敏感性,改善胰岛素抵抗。

Objective： To compare the effects of sitagliptin phosphate and glimepiride tablets in the treatment of type 2 diabetes mellitus （T2DM） combined with nonalcoholic fatty liver disease （NAFLD）.Methods： 60 patients with T2DM and NAFLD treated in our hospital from January 2014 to January 2017 were selected, and randomly divided into an observation group and a control group, with 30 patients in each group. The patients in the control group were treated with metformin and glimepiride tablets, and those in the observation group were treated as the control group with addition of sitagliptin phosphate. The glycosylated hemoglobin （HbAlc）, fasting blood glucose （FPG）, 2 h postprandial blood glucose （2 h PG）, triglyceride （TG）, low-density lipoprotein cholesterol （LDL-C）, total cholesterol （TC）, alanine aminotransferase （ALT）, aspartate aminotransferase （AST）, gamma-glutamyl transpeptidase （GGT）, insulin resistance index （HOMA-IR）, insulin sensitivity index （HOMA-IS）, body mass index （ I bm）, the curative effect on fatty liver and the incidence of adverse reactions were compared between the two groups.Results： The total response rate of fatty liver in the observation group was higher than that in the control group （ P 〈0.05）. The levels of HbAlc, FPG, 2 h PG, TG, LDL-C and TC as well as I bm in both groups were decreased significantly after treatment （ P 〈0.05）, but there was no significant difference between the two groups （ P 〉0.05）. The levels of ALT, AST and GGT as well as HOMA-IR in the observation group were significantly lower than those in the control group （ P 〈0.05）, while the HOMA-IS was significantly higher （ P 〈0.05）. There was no significant difference in the incidence of adverse reactions between the two groups （ P 〉0.05）.Conclusion： Sitagliptin phosphate could effectively reduce blood glucose, lipids levels and body mass, improve liver function, elevate insulin sensitivity, and ameliorate insulin resistance in patients with T2DM and NAFLD, and was safe.