二甲双胍联合辛伐他汀治疗非酒精性脂肪性肝病合并2型糖尿病患者疗效研究

Short-term impact of metformin an simvastatin combination therapy on blood glucose and lipid parameters in patients with nonalcoholic fatty liver disease with concomitant diabetes mellitus type 2

目的探讨应用二甲双胍联合辛伐他汀治疗非酒精性脂肪性肝病(NAFLD)合并2型糖尿病(T2DM)患者对血糖和血脂指标的影响。方法2018年1月~2020年6月我院诊治的NAFLD合并T2DM患者168例,其中75例接受二甲双胍治疗,另93例接受二甲双胍和辛伐他汀联合治疗,两组均观察3个月。常规检测血生化指标和糖化血红蛋白(HbA1c),采用放射免疫法测定空腹胰岛素(FINS),计算胰岛素抵抗指数(HOMA—IR)。结果两组患者在年龄、性别、体质指数(BMI)、血清FINS、合并高血压、代谢综合征或非酒精性脂肪性肝炎(NASH)等方面差异不具有统计学意义(P>0.05),具有可比性;在治疗3个月末,联合组HOMA—IR为1.8(1.0,2.7),显著低于二甲双胍治疗组【2.1(1.3,3.5),P<0.05】,而两组血清HbA1c和FINS水平比较,无显著性差异【分别为(6.4(6.0,7.0)%对(6.5(6.2,7.5)%和(5.5(2.2,7.6)μU/ml对(5.7(2.9,8.5)μU/ml,P>0.05】;联合组血清甘油三酯水平为2.1(1.9,3.3)mmol/l,显著低于二甲双胍治疗组【(2.7(2.1,3.5))mmol/l,P<0.05】,胆固醇为4.3(3.7,5.0)mmol/l,显著低于二甲双胍治疗组【5.4(5.0,6.2)mmol/l,P<0.05】,而血清高密度脂蛋白为1.7(1.5,2.6)mmol/l,显著高于二甲双胍治疗组【1.4(1.0,1.7)mmol/l,P<0.05】,但两组血清ALT【54(26,62)U/L对55(32,65)U/L,P>0.05】、AST【57(47,72)U/L对57(46,64)U/L,P>0.05】和低密度脂蛋白【2.5(2.2,3.3)mmol/l对2.6(2.1,3.4)mmol/l,P>0.05】无显著性差异。结论应用二甲双胍联合辛伐他汀治疗NAFLD合并T2DM患者可改善血糖和部分血脂指标水平,其对肝脂肪变的影响还需要进一步观察。

Objective The aim of this study was to investigate the short-term impact of metformin and simvastatin combination therapy on blood glucose and lipid parameters in patients with nonalcoholic fatty liver disease(NAFLD)with concomitant diabetes mellitus type 2(T2DM).Methods 168 patients with NAFLD and T2DM were encountered in our hospital between January 2018 and June 2020,and 75 patients were treated with metformin and another 93 patients received metformin and simvastatin combination therapy.The observation lasted for three months.Blood biochemical parameters,glycosylated hemoglobin(HbA1c)and fasting insulin(FINS)were detected,and the homeostasis model assessment of insulin resistance index(HOMA—IR)was calculated.Results There were no significant differences as respect to baseline materials such as age,gender,body mass index,serum FINS levels,concomitant hypertension,metabolic syndrome,or nonalcoholic steatohepatitis between the two groups(P>0.05);at the end of three month observation,the HOMA—IR in the combination group was 1.8(1.0,2.7),significantly lower than[2.1(1.3,3.5),P<0.05]in metformin-treated group,and there were no significant differences in blood HbA1c and FINS levels[(6.4(6.0,7.0)%vs.(6.5(6.2,7.5)%,and(5.5(2.2,7.6)μU/ml vs.(5.7(2.9,8.5))μU/ml,P>0.05]between the two groups;the blood triglyceride level in the combination group was 2.1(1.9,3.3)mmol/l,significantly lower than[(2.7(2.1,3.5))mmol/l,P<0.05],and blood total cholesterol level was 4.3(3.7,5.0)mmol/l,significantly lower than[5.4(5.0,6.2)mmol/l,P<0.05],while blood high-density lipoprotein cholesterol level was 1.7(1.5,2.6)mmol/l,significantly higher than[1.4(1.0,1.7)mmol/l,P<0.05]in metformin-treated patients,and there were no significant differences respect to serum alanine aminotransferase levels[54(26,62)U/L vs.55(32,65)U/L,P>0.05],serum aspartate aminotransferase levels[57(47,72)U/L vs.57(46,64)U/L,P>0.05]and serum low-density Lipoprotein cholesterol levels[2.5(2.2,3.3)mmol/l vs.2.6(2.1,3.4)mmol/l,P>0.05]between the two groups.Conclusion The combination of metformin and simvastatin in treatment of patients with NAFLD and T2DM could improve blood glucose and lipid metabolism,and what it impact on liver steatosis needs further investigation.