碳水化合物计数法对糖尿病合并非酒精性脂肪肝患者的疗效观察

Effects of carbohydrate counting on patients with type 2 diabetes mellitus combined non-alcoholic fatty liver disease

目的探讨碳水化合物计数法对2型糖尿病(T2DM)合并非酒精性脂肪肝(NAFLD)患者的疗效。方法 2014年12月—2016年12月,选取浙江医院门诊和中美糖尿病中心收治的仅口服常规药物治疗的T2DM合并NAFLD的患者共128例,采用随机数字表法分为实验组和对照组,其中,实验组65例,对照组63例。实验组实行碳水化合物计数法(包括对患者进行饮食宣教并指导患者如何管理饮食并根据碳水化合物交换份表配制标准化糖尿病套餐),对照组实行普通饮食干预。干预6个月,每周随访1次,测定干预前后空腹血糖(FPG)、餐后2 h血糖、糖化血红蛋白(HbA1c)和甘油三酯(TG)、胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、谷丙转氨酶(ALT)、谷草转氨酶(AST)等生化指标以及身高、体重、体质量指数(BMI)等人体测量指标,并统计和比较2组患者干预后肝功能恢复情况。结果实验组经碳水化合物计数法干预后,患者的FPG、餐后2 h血糖、HbA1c、TG、LDL-C较干预前显著降低(均P<0.05),TC、HDL-C干预前后比较差异没有统计学意义;对照组上述生化指标干预前后差异均没有统计学意义;干预后,实验组FPG、餐后2 h血糖、HbA1c、TG、LDL-C显著低于对照组(均P<0.05)。干预后,实验组和对照组患者的ALT、AST较干预前显著降低,且实验组ALT、AST显著低于对照组(均P<0.05);实验组肝功能恢复情况显著优于对照组(P<0.05)。结论该碳水化合物计数法饮食干预可以明显改善T2DM合并NAFLD患者的血糖、血脂水平,并可以改善其肝功能。

Objective To investigate the effects of carbohydrate counting on patients with type 2 diabetes mellitus combined non-alcoholic fatty liver disease. Methods A total of 128 subjects treated only with oral drug were included from Outpatient service and Diabetes center of China and the United States of Zhejiang hospital from December 2014 to December 2016. Subjects were divided into two group randomly, The experimental group was intervened by carbohydrate counting including the preparation of a standardized diabetic meal based on the carbohydrate exchange table for patients with the help of doctors. Control group was intervened by ordinary diet. Index of Fasting blood-glucose(FPG), 2 hours postprandial blood glucose, Hemoglobin A1 c(HbA1 c), Triglyceride(TG), Total cholesterol(TC), High density lipoprotein cholesterol(HDL-C), Low density lipoprotein cholesterol(LDL-C), Alanine aminotransferase(ALT), Aspartate aminotransferase(AST), height, body weight and Body mass index(BMI) were compared before and after 6 months of intervention, and liver function recovery after intervention were assessed. Results After the intervention, FPG, 2 hours postprandial blood glucose, HbA1 c, TG, LDL-C reduced observably, and significantly lower in the experimental group than those in the control group. After the intervention, the ALT and AST in two groups were reduced observably, and the ALT and AST in the experimental group were significantly lower than those in the control group, and the recovery of liver function in the experimental group was significantly better than that in the control group. Conclusion Carbohydrate counting method significantly ameliorated blood glucose levels, blood lipid levels and liver function in patients with type 2 diabetes mellitus combined non-alcoholic fatty liver disease.