磷酸西格列汀片可降低慢性乙型肝炎合并2型糖尿病患者血糖漂移幅度和改善肝纤维化

Sitagliptin phosphate tablets can reduce glucose excursion amplitude and improve liver fibrosis in patients with chronic hepatitis B and type 2 diabetes mellitus

目的:研究磷酸西格列汀片对慢性乙型肝炎(简称乙肝)合并2型糖尿病患者血糖漂移幅度和肝纤维化的影响。方法:选取海南医学院第一附属医院2016年6月-2018年6月收治的86例慢性乙肝合并2型糖尿病患者,随机分为对照组和观察组,各43例。2组患者均采取肝泰乐+维生素C片护肝以及恩替卡韦抗病毒治疗,对照组采取格列齐特60 mg/d,口服治疗,观察组采取磷酸西格列汀片100 mg/d,口服治疗,持续24周。比较2组患者治疗前和治疗24周后体质指数(BMI)、血糖、血糖漂移指标、肝功能、肝纤维化指标,记录治疗过程中出现的不良反应。结果:治疗24周后,2组患者的血糖指标明显降低(P均<0.05),但2组间相比差异无统计学意义(P>0.05);观察组患者的日内平均血糖漂移幅度(MAGE)、日间血糖漂移幅度(MODD)、平均血糖标准差(SDBG)、平均餐后血糖漂移幅度(MPPGE)显著低于对照组(P均<0.05);2组患者的丙氨酸转氨酶(ALT)、天门冬氨酸转氨酶(AST)、总胆红素(TBIL)、透明质酸(HA)、层黏连蛋白(LN)、Ⅲ型前胶原(PC-Ⅲ)、IV型胶原(IV-C)、转化生长因子-β(TGF-β)、肿瘤坏死因子-α(TNF-α)显著降低(P均<0.05),且观察组降低更显著(P均<0.05)。2组患者的不良反应发生率比较,差异无统计学意义(P>0.05)。结论:磷酸西格列汀片可有效降低慢性乙肝合并2型糖尿病患者血糖漂移幅度;通过降低长期高糖毒害,减轻炎症反应,从而改善肝纤维化。

Objective:To study the effects of sitagliptin phosphate tablets on glucose excursion amplitude and liver fibrosis in patients with chronic hepatitis B(CHB)and type 2 diabetes mellitus(T2DM).Methods:Totally,86 patients with CHB and T2DM who were admitted to the hospital between June 2016 and June 2018 were selected.According to the random number table method,the patients were divided into control group and observation group,43 cases in each group.Both groups were given glucurolactone and vitamin C tablets for liver protection,as well as entecavir for antiviral treatment.The control group was given oral gliclazide(60 mg/day),while observation group was given oral sitagliptin phosphate tablets(100 mg/day).The patients were continuously treated for 24 weeks.Before and after 24 weeks of treatment,the changes in body mass index(BMI),blood glucose indexes,glucose excursion indexes,liver function indexes and liver fibrosis indexes were compared between the two groups.The adverse reactions during treatment were recorded.Results:After treatment,blood glucose indexes in both groups were significantly decreased(P<0.05).There was no statistically significant difference between the two groups(P>0.05).After 24 weeks of treatment,daytime mean amplitude of glycemic excursion(MAGE),mean of daily differences(MODD),standard deviations of blood glucose(SDBG)and mean postprandial glucose excursion(MPPGE)were significantly lower in observation group than those in control group(P<0.05).After treatment,alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),hyaluronic acid(HA),laminin(LN),typeⅢprocollagen(PC-Ⅲ),type IV collagen(IV-C),transforming growth factor-β(TGF-β)and tumor necrosis factor-α(TNF-α)were significantly decreased in both groups(P<0.05).The decrease of the above indexes was more significant in observation group than in control group(P<0.05).There was no significant difference in incidence of adverse reactions between the two groups(P>0.05).Conclusion:Sitagliptin phosphate tablets can effectively reduce glucose excursion amplitude in patients with CHB and T2DM,which may improve liver fibrosis by reducing long-term high glucose toxicity and alleviating inflammation reactions.