利格列汀联合二甲双胍治疗T2DM合并NAFLD的效果观察

Observation of therapeutic effect of lisgliptin combined with metformin on T2DM complicated by NAFLD

目的探讨利格列汀联合二甲双胍(MET)治疗2型糖尿病(T2DM)合并非酒精性脂肪性肝病(NAFLD)的临床效果。方法抽取济南市第二人民医院2020年1月至2020年12月收治的T2DM合并NAFLD患者80例,根据随机数字表法分为对照组和观察组,每组40例。对照组给予MET治疗,观察组在对照组治疗基础上联合利格列汀治疗,连续治疗3个月。比较两组血糖指标、肝功能、肝脏弹性测量值(LSM)及血清组织蛋白酶D(CTSD)、血管生成素样蛋白4(ANGPTL4)水平,并统计不良反应发生情况。结果治疗后,两组患者糖化血红蛋白(HbA1c)、空腹血糖(FBG)、胰岛素抵抗指数(HOMA-IR)、丙氨酸氨基转移酶(ALT)、谷氨酰转肽酶(GGT)、天门冬氨酸氨基转移酶(AST)、LSM、CTSD、ANGPTL4水平均较治疗前下降,且观察组低于对照组(P<0.05)。观察组不良反应发生率(7.50%,3/40)与对照组(5.00%,2/40)比较差异未见统计学意义(P>0.05)。结论T2DM合并NAFLD患者应用利格列汀联合二甲双胍治疗,能有效控制患者血糖,改善肝功能及肝纤维化,下调血清CTSD、ANGPTL4水平,且安全性良好。

Objective To investigate the therapeutic effects of linagliptin combined with metformin(MET)on type 2 diabetes mellitus(T2DM)complicated by non-alcoholic fatty liver disease(NAFLD).Methods Eighty patients with T2DM complicated by NAFLD treated in Jinan Second People’s Hospital from January 2020 to December 2020 were selected,and they were divided into control group and observation group according to the random number table method,with 40 cases in each group.The control group was treated with MET,while the observation group was treated with linagliptin based on the treatment of the control group.Both groups were treated for 3 months continuously.The blood glucose indicators,liver function,levels of liver stiffness measurement(LSM),serum cathepsin D(CTSD)and angiopoietin-like 4(ANGPTL4)were compared between the two groups.The incidence of adverse reactions of the two groups were calculated.Results After treatment,the levels of glycosylated hemoglobin(HbA1c),fasting blood glucose(FBG),insulin resistance index(HOMA-IR),alanine aminotransferase(ALT),glutamyl transpeptidase(GGT),aspartate aminotransferase(AST),LSM,CTSD and ANGPTL4 in the two groups decreased,compare with these indexes before treatment,moreover,the levels in observation group were lower than those in the control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the observation group(7.50%,3/40)and the control group(5.00%,2/40),P>0.05.Conclusions Linagliptin combined with MET can effectively control blood glucose,improve liver function and liver fibrosis,and down-regulate levels of serum CTSD and ANGPTL4 in patients with T2DM complicated by NAFLD,with good safety.