恩格列净联合熊去氧胆酸对2型糖尿病合并非酒精性脂肪性肝病患者胰岛素抵抗、肝功能以及肝纤维化的影响

Effects of Empagliflozin Combined with Ursodeoxycholic Acid on Insulin Resistance,Liver Function and Liver Fibrosis in Patients with Type 2 Diabetes Complicated with Non-Alcoholic Fatty Liver Disease

目的:探讨恩格列净联合熊去氧胆酸对2型糖尿病合并非酒精性脂肪性肝病(NAFLD)患者胰岛素抵抗、肝功能以及肝纤维化的影响。方法:纳入2020年6月至2022年12月于该院就诊的2型糖尿病合并NAFLD患者108例,按随机数字表法分为对照组54例和研究组54例。对照组患者给予二甲双胍联合多烯磷脂酰胆碱治疗,研究组患者给予恩格列净联合熊去氧胆酸治疗。比较两组患者治疗前后胰岛素抵抗、肝功能以及炎症因子水平变化。结果:研究组患者治疗后糖化血红蛋白、空腹胰岛素、空腹血糖、胰岛素抵抗指数和餐后2 h血糖水平,体重指数、腰臀比明显低于治疗前和对照组治疗后,差异均有统计学意义(P<0.05);而对照组患者上述指标与治疗前的差异无统计学意义(P>0.05)。研究组患者治疗后天冬氨酸转氨酶、丙氨酸转氨酶、γ-谷氨酰转移酶、总胆红素水平以及肝脏硬度明显低于治疗前和对照组治疗后,差异均有统计学意义(P<0.05)。研究组患者治疗后肿瘤坏死因子α、白细胞介素6以及C反应蛋白水平明显低于治疗前和对照组治疗后,差异均有统计学意义(P<0.05)。结论:恩格列净联合熊去氧胆酸可明显降低2型糖尿病合并NAFLD患者的胰岛素抵抗水平,减轻肝损伤,改善肝纤维化程度,降低血清炎症因子水平。

OBJECTIVE:To probe into the effects of empagliflozin combined with ursodeoxycholic acid on insulin resistance,liver function and liver fibrosis in patients with type 2 diabetes complicated with non-alcoholic fatty liver disease(NAFLD).METHODS:A total of 108 patients with type 2 diabetes complicated with NAFLD admitted into the hospital from Jun.2020 to Dec.2022 were selected to be divided into 54 cases in the control group and 54 cases in the research group via random number table method.The control group was given metformin combined with polyene phosphatidyl choline,while the research group was given empagliflozin combined with ursodeoxycholic acid.The changes of insulin resistance,liver function and inflammatory factor levels were compared between two groups before and after treatment.RESULTS:The glycosylated hemoglobin,fasting insulin,fasting blood glucose,insulin resistance index(HOMA-IR)and 2 h postprandial blood glucose,body mass index and waist-hip ratio of the research group after treatment were significantly lower than those before treatment and the control group after treatment,with statistically significant differences(P<0.05),the differences of the above indicators in the control group were not statistically significant before and after treatment(P>0.05).Aspartate transaminase,alanine aminotransferase,γ-glutamyltranspeptidase,total bilirubin and liver stiffness of the research group after treatment were significantly lower than those before treatment and the control group after treatment,with statistically significant differences(P<0.05).The tumor necrosis factor-α,interleukin-6 and C reactive protein of the research group after treatment were significantly lower than those before treatment and the control group after treatment,with statistically significant differences(P<0.05).CONCLUSIONS:The combination of empagliflozin with ursodeoxycholic acid can significantly reduce the insulin resistance level,alleviate liver injury,improve liver fibrosis and reduce serum inflammatory factors in patients with type 2 diabetes complicated with NAFLD.