利拉鲁肽对2型糖尿病合并非酒精性脂肪肝患者的影响及机制探究

Effect of liraglutide on type 2 diabetes combines with nonalcoholic fatty liver disease and mechanism research

目的:利拉鲁肽对2型糖尿病(T2DM)合并非酒精性脂肪肝(NAFLD)患者用药后各指标的影响,以及探讨利拉鲁肽的用药机制。方法:入选T2DM合并NAFLD患者80例,按随机数字表法分为A组(40例):给予二甲双胍联合利拉鲁肽治疗24周。B组(40例):口服二甲双胍联合促泌剂和/或α-糖苷酶抑制剂治疗。观察治疗24周前后2组患者体质量、腰围、血糖、血脂、HOMA-IR、脂肪肝指数(FLI)及FGF-21等的变化,分析利拉鲁肽对T2DM合并NAFLD的FLI及FGF-21的影响。结果:利拉鲁肽治疗24周后,BMI、WC、FBG、HbA1c、HOMA-IR、TG、TC、LDL、FLI及FGF-21较治疗前明显下降(P<0.05),△FBG、△HbA1c、△TG、△HOMA-IR、△FLI,A组明显高于B组(P<0.05);FLI和HOMA-IR是影响血清FGF-21的独立危险因素,回归方程为:YFGF-21 =10.396+2.371×XHOMA-IR+0.971×XFLI (R2=0.6,F=38.94,P<0.05)。结论:利拉鲁肽可显著降低T2DM合并NAFLD患者的FLI和FGF-21,利拉鲁肽改善NAFLD与减轻FGF-21抵抗的用药机制可能和胰岛素抵抗有关。

OBJECTIVE To evaluate the effect of liraglutide on various parameters in patients with type 2 diabetes mellitus(T2 DM)complicated with nonalcoholic fatty liver disease(NAFLD)after treatment,and to explore the mechanism of liraglutide.METHODS Eighty patients with type 2 diabetes mellitus complicated with nonalcoholic fatty liver disease were enrolled.They were randomly divided into two groups.In group A(40 cases),metformin combined liraglutide was given for 24 weeks.In group B(40 cases),metformin combined with gastrin and/or alpha-glucosidase inhibitors was administered for 24 weeks.The changes of body weight,waist circumference,blood glucose,blood lipids,HOMA-IR,fatty liver index(FLI)and FGF-21 were observed in the two groups before and after treatment for 24 weeks.The effects of liraglutide on FLI and FGF-21 in T2 DM combined with NAFLD were analyzed.RESULTS After 24 weeks of treatment with liraglutide,BMI,WC,FBG,HbA1 c,HOMA-IR,TG,TC,LDL,FLI and FGF-21 were significantly decreased compared with those before treatment(P<0.05).△FBG,△HbA1 c,△TG,△HOMA-IR,△FLI in group A were significantly higher than those in group B(P<0.05).FLI and HOMA-IR were independent risk factors for serum FGF-21.The regression equation was:YFGF-21=10.396+2.371×XHOMA-IR+0.971×XFLI(R2=0.6,F=38.94,P<0.05).CONCLUSION Liraglutide can significantly reduce FLI and FGF-21 in patients with T2 DM and NAFLD.The mechanism of liraglutide improving NAFLD and reducing FGF-21 resistance may be related to insulin resistance.