度拉糖肽对2型糖尿病合并代谢相关脂肪性肝病的影响

Effect of dulaglutide on type 2 diabetes mellitus with metabolic-associated fatty liver disease

目的:探讨度拉糖肽对2型糖尿病合并代谢相关性脂肪性肝病患者肝脂肪变和肝纤维化相关指标的影响。方法:选取2020年4月至2020年8月就诊于吉林大学第二医院内分泌科的2型糖尿病合并代谢相关性脂肪性肝病患者100例,随机分为对照组(甘精胰岛素组)与观察组(度拉糖肽组),每组50例。比较两组治疗24周前后的临床生化指标。结果:治疗24周时,观察组体重、BMI较基线显著下降,对照组较基线无显著变化(P<0.05)。丙氨酸氨基转移酶(alanine aminotransferase,ALT)、天门冬氨酸氨基转移酶(aspartate amino transferase,AST)、肝硬度值(liver stiffness measurement,LSM)和脂肪受控衰减参数(controlled attenuation parameter,CAP)水平较治疗前均下降,其中观察组下降水平更明显(P<0.05)。空腹血糖(fasting blood-glucose,FPG)、HbA1c、空腹胰岛素(fasting insulin,FINS)、胰岛素抵抗指数(homeostasis model assessment of insul in resistance index,HOMAIR)、三酰甘油(triglyc-erides,TG)、总胆固醇(total cholesterol,TC)及低密度脂蛋白胆固醇(low density lipoproteincholesterol,LDL-C)水平较治疗前均下降(P<0.05),其中观察组HOMA-IR下降水平更明显(P<0.05);高密度脂蛋白胆固醇(high density lipoprotein-cholesterol,HDL-C)和TIR水平均升高(P<0.05),且观察组范围内时间(time in range,TIR)升高水平更明显(P<0.05)。结论:度拉糖肽在治疗合并MAFLD的T2DM患者中可能是一种有效的药物,可以改善肝脂肪变、肝脏炎症及肝纤维化。

Objective:To investigate the effect of dulaglutide on hepatic adipoosis and liver fibrosis in type 2 diabetes combined with metabolic-related fatty liver disease.Methods:A total of 100 patients with type 2 diabetes and metabolic-related fatty liver disease in the Department of Endocrinology of the Second Hospital of Jilin University from April 2020 to August 2020,randomly divided into a control group(insulin glargine group)and an observation group(dulaglutide group),50 cases in each group.Clinical biochemical measures were compared between the two groups around 24 weeks of treatment.Results:At 24 weeks of treatment,significant decreases in weight and body mass index(BMI)were observed in the observed group and no significant change from baseline in the control group(all P<0.05).Both alanine aminotransferase(ALT),aspartate amino transferase(AST),liver stiffness measurement(LSM)and controlled attenuation parameter(CAP)levels decreased compared with before the treatment,and more pronounced decreased levels in the observed group(all P<0.05).Both fasting blood-glucose(FPG),HbA1c,fasting insulin(FINS),homeostasis model assessment of insul in resistance index(HOMA-IR),triglyc-erides(TG),total cholesterol(TC)and low density lipoproteincholesterol(LDL-C)levels decreased compared to before the treatment(all P<0.05),and the levels of HOMA-IR decreased more obviously in the observation group(P<0.05);higher high density lipoprotein-cholesterol(HDL-C)levels(P<0.05)and higher time in range(TIR)in the observed group(P<0.05).Conclusion:Dulaglutide may be an effective drug in treating type 2 diabetes patients with metabolic-associated fatty liver disease to improve liver adiatosis,liver inflammation and liver fibrosis.