达格列净联合二甲双胍对2型糖尿病合并非酒精性脂肪性肝病患者肝脂肪变性的影响

Effects of Dapagliflozin Combined with Metformin on Liver Steatosisin Type2 Diabetic Patients with Nonalcoholic Fatty Liver Disease

目的探讨达格列净联合二甲双胍对2型糖尿病(T2DM)合并非酒精性脂肪性肝病(NAFLD)患者肝脂肪变性及炎性细胞因子的影响。方法回顾性分析84例T2DM并发NAFLD且未曾接受过任何治疗患者的临床资料,其中格列美脲组(格列美脲+二甲双胍治疗12周)42例,达格列净组(达格列净+二甲双胍治疗12周)42例。收集患者治疗前后的身高、体质量等,计算身体质量指数(BMI);收集患者治疗前后各项血清生化指标[空腹血浆胰岛素(FIN)、空腹血糖(FBG)、糖化血红蛋白(HbA1C)、血胆固醇(TC)、三酰甘油(TG)]和炎性细胞因子[白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]。收集2组患者治疗前后肝脏CT情况,评估肝脂肪变性的程度。结果治疗12周后,与治疗前比较,格列美脲组和达格列净组BMI、FBG、FIN、HbA1C、TC、TG、稳态模型胰岛素抵抗指数(HOMA-IR)、IL-1β、IL-6、TNF-α降低(均P<0.05);治疗12周后,与格列美脲组比较,达格列净组BMI、FIN、TC、TG、HOMA-IR、IL-1β、IL-6、TNF-α降低(均P<0.05)。治疗12周后,达格列净组总有效率69.05%,格列美脲组总有效率45.24%(P<0.05)。治疗期间,达格列净组低血糖发生率比格列美脲组更低(P<0.05)。结论达格列净联合二甲双胍治疗T2DM合并NAFLD疗效明确,炎性细胞因子水平降低,肝脏脂肪变性程度减轻,其疗效优于格列美脲联合二甲双胍,安全性好。

Objective To investigate the effects of dapagliflozin combined with metformin on liver steatosis in type 2 diabet-ic patients with nonalcoholic fatty liver disease.Methods In all,84 type 2 diabetic patients with nonalcoholic fatty liver disease,.who had not received any treatment,were divided into glimepiride group(n-42)and dapagliflozin group(n-42).Patients in glimepiride group received glimepiride+metformin for 12 weeks.Patients in dapagliflozin group received dapagliflozin+met-formin for 12 weeks.Before and after treatment,body mass index(BMI),fasting blood glucose(FBG),fasting plasma insulin(FIN),glycosylated hemoglobin(HbA1C),cholesterol(TC),triacylglycerol(TG),homeostasis model assessment of insulin re-sistance(HOMA-IR),inflammatory cytokines[interleukin-1 beta(IL-1β),interleukin-6(IL-6),tumor necrosis factor-alpha(TNF-α)]were detected in both groups.Furthermore,all patients completed CT examination to evaluate the degree of liver steato-sis.Results BMI,FBG,FIN,HbA1C,TC,TG,HOMA-IR,IL-1β,IL-6,TNF-α in both groups were decreased after treatment compared with the original(all P<0.05).After treatment,BMI,FIN,TC,TG,HOMA-IR,IL-1β,IL-6,TNF-α in dapagliflozin group were decreased significantly compared with glimepiride group,the comparative difference was statistically significant(all P<0.05).After treatment,the total effective rate of dapagliflozin group was 69.05%;the total effective rate of glimepiride group was 45.24%,the comparative difference was statistically significant(P<0.05).The incidence of hypoglycemia in dapagli-flozin group was lower than that in glimepiride group(P<0.05).Conclusion Dapagliflozin combined with metformin was effec-tive and secure in the treatment of type 2 diabetic patients with nonalcoholic fatty liver disease,reduced levels of inflammatory cytokines,reduced the degree of liver steatosis+which were better than glimepiride combined with metformin.