度拉糖肽治疗2型糖尿病合并非酒精性脂肪肝效果及对患者氧化应激的影响

Effect of Dulaglutide on type 2 diabetes patients with nonalcoholic fatty liver and oxidative stress

目的观察度拉糖肽治疗2型糖尿病合并非酒精性脂肪肝效果及对患者氧化应激的影响。方法前瞻区选取2021年5月~2022年2月于廊坊市人民医院就诊的2型糖尿病合并非酒精性脂肪肝患者120例,随机数表法分为胰岛素组和度拉糖肽组,每组各60例。两组均进行生活方式干预,予以保肝、降脂等治疗。在此基础上,胰岛素组注射地特胰岛素,度拉糖肽组使用度拉糖肽注射液。两组均持续治疗32周。比较治疗前后血糖、血脂、体重、肝∕脾CT值及氧化应激指标丙二醛(MDA)、8-异前列腺素F2α(8-iso-PGF2α)、谷胱甘肽过氧化物酶(GSH-Px),分析MDA、8-iso-PGF2α、GSH-Px与CT值的相关性。结果入组时,两组空腹血糖(FPG)、糖化血红蛋白(HbA1c)、血清总胆固醇(TC)、三酰甘油(TG)、体重、肝∕脾CT值、MDA、8-iso-PGF2α、GSH-Px比较,差异无统计学意义(P>0.05)。治疗后胰岛素组FPG和HbA1c低于度拉糖肽组,其中FPG组间差异有统计学意义(P<0.05)。度拉糖肽组TC、TG均低于胰岛素组,组间差异有统计学意义(P<0.05)。治疗后胰岛素组体重上升,度拉糖肽组体重下降,但组间差异无统计学意义(P>0.05)。两组治疗前后体重差值比较,差异有统计学意义(P<0.05)。治疗后度拉糖肽组肝∕脾CT值升高,且高于胰岛素组,组间差异有统计学意义(P<0.05)。治疗后度拉糖肽组MDA、8-iso-PGF2α低于胰岛素组,GSH-Px高于胰岛素组,组间差异有统计学意义(P<0.05)。MDA、8-iso-PGF2α与肝∕脾CT值负相关(r=-0.218、-0.435,P<0.05)。结论度拉糖肽治疗2型糖尿病合并非酒精性脂肪肝能降低患者血脂、血糖、减轻肝脂肪变,这可能与其改善氧化应激及脂质过氧化有关。

Objective To observe the effect of dulaglutide on type 2 diabetes patients with nonalcoholic fatty liver disease(NAFLD)and its effect on oxidative stress.Methods 120 patients with type 2 diabetes mellitus and nonalcoholic fatty liver from May 2021 to February 2022 were randomly divided into insulin group and dulaglutide group with 60 cases in each group.Both groups received lifestyle intervention.According to the condition of the patients,they should be treated with liver protection and lipid reduction.On this basis,the insulin group was injected with insulin dette,and the dulaglutide group was injected with dulaglutide injection.Both groups were treated for 32 weeks.The blood glucose,blood lipid,weight,liver∕spleen CT value and oxidative stress index MDA,8-iso-prostaglandin F2α(8-iso-PGF2α)and glutathione peroxidase(GSH-Px)were compared before and after treatment.Analyze the correlation between MDA,8-iso-PGF2α,GSH-Px and CT value.Results There was no statistically significant difference in FPG,HbA1c,TC,TG,weight,liver∕spleen CT value,MDA,8-iso-PGF2α,GSH-Px between the two groups at the time of enrollment(P>0.05).After treatment,the FPG and HbA1c in insulin group were lower than those in dulaglutide group,and the difference between FPG groups was statistically significant(P<0.05).TC and TG in dulaglutide group were lower than those in insulin group,and the difference between groups was statistically significant(P<0.05).After treatment,the weight of insulin group increased,while that of dulaglutide group decreased.There was no statistically significant difference between the two groups.The difference of body weight between the two groups before and after treatment was statistically significant(P<0.05).After treatment,the CT value of liver∕spleen in dulaglutide group was higher than that in insulin group,and the difference between groups was statistically significant(P<0.05).After treatment,MDA and 8-iso-PGF2αin dulaglutide group were lower than that in insulin group,and GSH-Px was higher than that in insulin group.The difference between groups was statistically significant(P<0.05).MDA and 8-iso-PGF2αwere negatively correlated with liver∕spleen CT values(r=-0.218.-0.435,P<0.05).Conclusion Dulaglutide treatment of type 2 diabetes with nonalcoholic fatty liver can reduce blood lipid,blood sugar and liver steatosis,which may be related to its ability to improve oxygen stress and lipid peroxidation.