度拉糖肽对肥胖2型糖尿病合并非酒精性脂肪性肝病患者肝脏脂肪含量的影响

Effect of dulaglutide on liver fat content in type 2 diabetic patients with non-alcoholic liver disease

目的观察度拉糖肽对肥胖2型糖尿病(T2DM)合并非酒精性脂肪性肝病(NAFLD)患者肝脏脂肪含量的影响。方法选取2020年11月至2021年7月在保定市第一中心医院门诊及住院的肥胖T2DM合并NAFLD患者64例,给予度拉糖肽治疗42例(度拉糖肽组),给予利拉鲁肽治疗22例(利拉鲁肽组),共24周。观察两组患者治疗前后体重、腰围、血脂、FPG及糖化血红蛋白(HbA1C)、ALT、AST、CRP;计算两组患者BMI、稳态模型评估胰岛素抵抗指数(HOMA-IR)及肝纤维化4因子指数(Fib-4);测定肝脏脂肪衰减值(CAP)及肝/脾CT值,计算肝/脾CT比值。结果治疗24周后,与治疗前比较,度拉糖肽组患者体重、BMI、腰围、肝酶、Fib-4、CRP、CAP下降,糖脂代谢紊乱改善,肝/脾CT比值升高,差异均有统计学意义(均P<0.05)。与利拉鲁肽组比较,度拉糖肽组患者体重、BMI、腰围、HOMA-IR和CAP水平降低,肝/脾CT比值升高,差异均有统计学意义(均P<0.05)。相关性分析显示,度拉糖肽组体重、BMI、HbA1C下降水平与CAP下降水平均呈正相关(r=0.412、0.405、0.327,均P<0.05);体重、BMI、FPG、HOMA-IR下降水平与肝/脾CT比值升高水平均呈负相关(r=-0.391、-0.449、-0.539、-0.458,均P<0.05)。多元线性回归分析显示,体重、HbA1C下降水平是CAP下降的影响因素(均P<0.05);FPG、BMI下降水平是肝/脾CT比值升高的影响因素(均P<0.05)。结论度拉糖肽能够有效降低肥胖T2DM合并NAFLD患者的肝脏脂肪含量,肝脏脂肪含量下降与体重及血糖水平下降密切相关。

Objective To assess the effect of dulaglutide on liver fat content in type 2 diabetic melitus(T2DM)patients and non-alcoholic fatty liver disease(NAFLD).Methods Sixty-four overweight or obese T2DM patients with NAFLD were recruited in Baoding NO.1 Central Hospital from November 2020 to July 2021,including 42 patients treated with dulaglutide and 22 patients treated with liraglutide for 24 weeks.Body weight,waist circumference,blood lipids and blood glucose profile,glycosylated hemoglobin Aic,alanine aminotransferase(ALT),aspartate aminotransferase(AST)and C-reactive protein(CRP)were measured.Body mass index(BMI),homeostatic model assessment-insulin resistance index(HOMA-IR)and fibrosis index based on the 4 factor(Fib-4)were measured.Controlled attenuation parameters(CAP)and CT values of liver and spleen were measured,and the liver-to-spleen attenuation ratio(L/S CT ratio)was calculated.Results After 24 weeks of treatment,the body weight,BMI,waist circumference,liver enzyme,Fib-4,CRP,CAP decreased,glucose and lipid metabolism improved and L/S CT ratio increased in dulaglutide group(all P<0.05);compared with liraglutide treatment group,the levels of weight,BMI,waist circumference,HOMA-IR and CAP were lower,and the level of L/S CT ratio was higher in dulaglutide group(all P<0.05).In dulaglutide group the decrease of body weight,BMI and glycosylated hemoglobin Aic were positively correlated with the decrease of CAP(r=0.412,0.405,0.327,all P<0.05);the decrease of weight,BMI,fasting blood glucose and HOMA-IR were negatively correlated with the increase of L/S CT ratio(r=-0.391,-0.449,-0.539,-0.458,all P<0.05).Multiple linear regression analysis showed that the decrease of weight and glycosylated hemoglobin Aic were the independent influencing factors of CAP decline,and the decrease of fasting blood glucose and BMI were the independent influencing factors of the L/S CT ratio increment(all P<0.05).Conclusion Dulaglutide can effectively reduce liver fat content in T2DM patients with NAFLD.The decline of liver fat content is closely related to the decline of body weight and blood glucose level.